***Disclaimers																																													
																																													
*Inclusion or exclusion of a procedure, supply, product, or service does not imply any health insurance coverage or reimbursement policy. 																																													
																																													
*In some instances, brand names may appear in HCPCS descriptions.  These names have been included for indexing purposes only; their inclusion does not 																																													
   convey endorsement of any particular brand.  																																													


   A1001007Dressing for one wound                                                          Dressing for one wound                                                                                                                    C                                      2002070120020701        N                           
   A2001007Dressing for two wounds                                                         Dressing for two wounds                                                                                                                   C                                      2002070120020701        N                           
   A3001007Dressing for three wounds                                                       Dressing for three wounds                                                                                                                 C                                      2002070120020701        N                           
   A4001007Dressing for four wounds                                                        Dressing for four wounds                                                                                                                  C                                      2002070120020701        N                           
   A5001007Dressing for five wounds                                                        Dressing for five wounds                                                                                                                  C                                      2002070120020701        N                           
   A6001007Dressing for six wounds                                                         Dressing for six wounds                                                                                                                   C                                      2002070120020701        N                           
   A7001007Dressing for seven wounds                                                       Dressing for seven wounds                                                                                                                 C                                      2002070120020701        N                           
   A8001007Dressing for eight wounds                                                       Dressing for eight wounds                                                                                                                 C                                      2002070120020701        N                           
   A9001007Dressing for nine or more wounds                                                Dressing for 9 or more wound                                                                                                              C                                      2002070120020701        N                           
   AA001007Anesthesia services performed personally by anesthesiologist                    Anesthesia perf by anesgst                             3350.5                                                                             D                                      1984010120010101        N                           
   AD001007Medical supervision by a physician: more than four concurrent anesthesia        Md supervision, >4 anes proc                           3350.5                                                                             D                                      1984010120010101        N                           
   AD002008procedures                                                                                                                                                                                                                                                                                                           
   AE001007Registered dietician                                                            Registered dietician                                                                                                                      C                                      2005010120050101        N                           
   AF001007Specialty physician                                                             Specialty physician                                                                                                                       C                                      2005010120050101        N                           
   AG001007Primary physician                                                               Primary physician                                                                                                                         C                                      2005010120050101        N                           
   AH001007Clinical psychologist                                                           Clinical psychologist                                  2150    5112                                                                       D                                      1991010119970101        N                           
   AI001007Principal physician of record                                                   Principal physician of rec                                                                                                                C                                      2010010120100101        N                           
   AJ001007Clinical social worker                                                          Clinical social worker                                 2152    5113                                                                       D                                      1991010119970101        N                           
   AK001007Non participating physician                                                     Non participating physician                                                                                                               C                                      2005010120050101        N                           
   AM001007Physician, team member service                                                  Physician, team member svc                             4105.7                                                    QM                       D                      0069            1991010119970101        N                           
   AO001007Alternate payment method declined by provider of service                        Prov declined alt pmt method                                                                                                              C                                      2013100120131001        N                           
   AP001007Determination of refractive state was not performed in the course of diagnostic No dtmn of refractive state                                                                                                               C                                      1984010119970101        N                           
   AP002008ophthalmological examination                                                                                                                                                                                                                                                                                         
   AQ001007Physician providing a service in an unlisted health professional shortage area  Physician service hpsa area                                                                                                               C                                      2006010120060101        N                           
   AQ002008(hpsa)                                                                                                                                                                                                                                                                                                               
   AR001007Physician provider services in a physician scarcity area                        Physician scarcity area                                                                                                                   C                                      2005010120050101        N                           
   AS001007Physician assistant, nurse practitioner, or clinical nurse specialist services  Assistant at surgery service                                                                                                              C                      0069            1988010119990101        N                           
   AS002008for assistant at surgery                                                                                                                                                                                                                                                                                             
   AT001007Acute treatment (this modifier should be used when reporting service 98940,     Acute treatment                                                                                                                           C                                      1984010119980101        N                           
   AT00200898941, 98942)                                                                                                                                                                                                                                                                                                        
   AU001007Item furnished in conjunction with a urological, ostomy, or tracheostomy supply Uro, ostomy or trach item                                                                                                                 C                                      2003010120030101        N                           
   AV001007Item furnished in conjunction with a prosthetic device, prosthetic or orthotic  Item w prosthetic/orthotic                                                                                                                C                                      2003010120030101        N                           
   AW001007Item furnished in conjunction with a surgical dressing                          Item w a surgical dressing                                                                                                                C                                      2003010120030101        N                           
   AX001007Item furnished in conjunction with dialysis services                            Item w dialysis services                                                                                                                  C                      0000            2003010120030101        N                           
   AY001007Item or service furnished to an esrd patient that is not for the treatment of   Item/service not for esrd tx                                                                                                              C                                      2011010120110101        N                           
   AY002008esrd                                                                                                                                                                                                                                                                                                                 
   AZ001007Physician providing a service in a dental health professional shortage area for Physician serv in dent hpsa                                                                                                               I                                      2011010120110101        N                           
   AZ002008the purpose of an electronic health record incentive payment                                                                                                                                                                                                                                                         
   BA001007Item furnished in conjunction with parenteral enteral nutrition (pen) services  Item w pen services                                                                                                                       C                                      2003010120030101        N                           
   BL001007Special acquisition of blood and blood products                                 Spec acquisition blood prods                                                                                                              C                                      2005070120050701        N                           
   BO001007Orally administered nutrition, not by feeding tube                              Nutrition oral admin no tube                                                                                                              C                                      2003010120030101        N                           
   BP001007The beneficiary has been informed of the purchase and rental options and has    Bene electd to purchase item                                                                                                              C                                      1992010119970101        N                           
   BP002008elected to purchase the item                                                                                                                                                                                                                                                                                         
   BR001007The beneficiary has been informed of the purchase and rental options and has    Bene elected to rent item                                                                                                                 C                                      1992010119970101        N                           
   BR002008elected to rent the item                                                                                                                                                                                                                                                                                             
   BU001007The beneficiary has been informed of the purchase and rental options and after  Bene undecided on purch/rent                                                                                                              C                                      1992010119970101        N                           
   BU00200830 days has not informed the supplier of his/her decision                                                                                                                                                                                                                                                            
   CA001007Procedure payable only in the inpatient setting when performed emergently on an Procedure payable inpatient                                                                                                               C                                      2003010120030101        N                           
   CA002008outpatient who expires prior to admission                                                                                                                                                                                                                                                                            
   CB001007Service ordered by a renal dialysis facility (rdf) physician as part of the     Esrd bene part a snf-sep pay                                                                                                              C                                      2003040120040101        N                           
   CB002008esrd beneficiary's dialysis benefit, is not part of the composite rate, and is                                                                                                                                                                                                                                       
   CB003008separately reimbursable                                                                                                                                                                                                                                                                                              
   CC001007Procedure code change (use 'cc' when the procedure code submitted was changed   Procedure code change                                                                                                                     C                                      1990010119970101        N                           
   CC002008either for administrative reasons or because an incorrect code was filed)                                                                                                                                                                                                                                            
   CD001007Amcc test has been ordered by an esrd facility or mcp physician that is part of Amcc test for esrd or mcp md                           4270.2                                                                             D                                      2004010120040101        N                           
   CD002008the composite rate and is not separately billable                                                                                                                                                                                                                                                                    
   CE001007Amcc test has been ordered by an esrd facility or mcp physician that is a       Med neces amcc tst sep reimb                           4270.2                                                                             D                                      2004010120040101        N                           
   CE002008composite rate test but is beyond the normal frequency covered under the rate                                                                                                                                                                                                                                        
   CE003008and is separately reimbursable based on medical necessity                                                                                                                                                                                                                                                            
   CF001007Amcc test has been ordered by an esrd facility or mcp physician that is not     Amcc tst not composite rate                            4270.2                                                                             D                                      2004010120040101        N                           
   CF002008part of the composite rate and is separately billable                                                                                                                                                                                                                                                                
   CG001007Policy criteria applied                                                         Policy criteria applied                                                                                                                   C                                      2008070120080701        N                           
   CH0010070 percent impaired, limited or restricted                                       0 percent impaired, ltd, res                                                                                                              D                      0180            2013010120130101        N                           
   CI001007At least 1 percent but less than 20 percent impaired, limited or restricted     1 to <20 percent impaired                                                                                                                 D                      0180            2013010120130101        N                           
   CJ001007At least 20 percent but less than 40 percent impaired, limited or restricted    20 to <40 percent impaired                                                                                                                D                      0180            2013010120130101        N                           
   CK001007At least 40 percent but less than 60 percent impaired, limited or restricted    40 to <60 percent impaired                                                                                                                D                      0180            2013010120130101        N                           
   CL001007At least 60 percent but less than 80 percent impaired, limited or restricted    60 to <80 percent impaired                                                                                                                D                      0180            2013010120130101        N                           
   CM001007At least 80 percent but less than 100 percent impaired, limited or restricted   80 to <100 percent impaired                                                                                                               D                      0180            2013010120130101        N                           
   CN001007100 percent impaired, limited or restricted                                     100 percent impaired, ltd                                                                                                                 D                      0180            2013010120130101        N                           
   CO001007Outpatient occupational therapy services furnished in whole or in part by an    Outpatient ot service by ota                                                                                                              C                                      2019010120190101        A                           
   CO002008occupational therapy assistant                                                                                                                                                                                                                                                                                       
   CP001007Adjunctive service related to a procedure assigned to a comprehensive           C-apc adjunctive service                                                                                                                  C                                      201601012018010120171231N                           
   CP002008ambulatory payment classification (c-apc) procedure, but reported on a                                                                                                                                                                                                                                               
   CP003008different claim                                                                                                                                                                                                                                                                                                      
   CQ001007Outpatient physical therapy services furnished in whole or in part by a         Outpatient pt service by pta                                                                                                              C                                      2019010120190101        A                           
   CQ002008physical therapist assistant                                                                                                                                                                                                                                                                                         
   CR001007Catastrophe/disaster related                                                    Catastrophe/disaster related                                                                                                              C                                      2005082120050821        N                           
   CS001007Item or service related, in whole or in part, to an illness, injury, or         Gulf oil 2010 spill related                                                                                                               C                                      2011010120110101        N                           
   CS002008condition that was caused by or exacerbated by the effects, direct or indirect,                                                                                                                                                                                                                                      
   CS003008of the 2010 oil spill in the gulf of mexico, including but not limited to                                                                                                                                                                                                                                            
   CS004008subsequent clean-up activities                                                                                                                                                                                                                                                                                       
   CT001007Computed tomography services furnished using equipment that does not meet each  Ct does not meet nema standa                                                                                                              C                                      2016010120160101        N                           
   CT002008of the attributes of the national electrical manufacturers association (nema)                                                                                                                                                                                                                                        
   CT003008xr-29-2013 standard                                                                                                                                                                                                                                                                                                  
   E1001007Upper left, eyelid                                                              Upper left eyelid                                                                                                                         C                                      1995010119990101        N                           
   E2001007Lower left, eyelid                                                              Lower left eyelid                                                                                                                         C                                      1995010119990101        N                           
   E3001007Upper right, eyelid                                                             Upper right eyelid                                                                                                                        C                                      1995010119990101        N                           
   E4001007Lower right, eyelid                                                             Lower right eyelid                                                                                                                        C                                      1995010119990101        N                           
   EA001007Erythropoetic stimulating agent (esa) administered to treat anemia due to       Esa, anemia, chemo-induced                                                                                                                D                      0147            2008010120080101        N                           
   EA002008anti-cancer chemotherapy                                                                                                                                                                                                                                                                                             
   EB001007Erythropoetic stimulating agent (esa) administered to treat anemia due to       Esa, anemia, radio-induced                                                                                                                D                      0147            2008010120080101        N                           
   EB002008anti-cancer radiotherapy                                                                                                                                                                                                                                                                                             
   EC001007Erythropoetic stimulating agent (esa) administered to treat anemia not due to   Esa, anemia, non-chemo/radio                                                                                                              D                      0147            2008010120080101        N                           
   EC002008anti-cancer radiotherapy or anti-cancer chemotherapy                                                                                                                                                                                                                                                                 
   ED001007Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl)  Hct>39% or hgb>13g>=3 cycle                                                                                                               D                      0145            2008010120080101        N                           
   ED002008for 3 or more consecutive billing cycles immediately prior to and including the                                                                                                                                                                                                                                      
   ED003008current cycle                                                                                                                                                                                                                                                                                                        
   EE001007Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded     Hct>39% or hgb>13g<3 cycle                                                                                                                D                      0145            2008010120080101        N                           
   EE00200813.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and                                                                                                                                                                                                                                         
   EE003008including the current cycle                                                                                                                                                                                                                                                                                          
   EJ001007Subsequent claims for a defined course of therapy, e.g., epo, sodium            Subsequent claim                                       4273.2                                                                             D                                      1991010120000101        N                           
   EJ002008hyaluronate, infliximab                                                                                                                                                                                                                                                                                              
   EM001007Emergency reserve supply (for esrd benefit only)                                Emer reserve supply (esrd)                             3045.7                                                                             D                                      1991010119970101        N                           
   EP001007Service provided as part of medicaid early periodic screening diagnosis and     Medicaid epsdt program svc                                                                                                                C                                      1987010119970101        N                           
   EP002008treatment (epsdt) program                                                                                                                                                                                                                                                                                            
   ER001007Items and services furnished by a provider-based, off-campus emergency          Off-campus ed service                                                                                                                     C                                      2019010120190101        A                           
   ER002008department                                                                                                                                                                                                                                                                                                           
   ET001007Emergency services                                                              Emergency services                                                                                                                        C                                      1984010120020101        N                           
   EX001007Expatriate beneficiary                                                          Expatriate beneficiary                                                                                                                    C                                      2015040120150401        N                           
   EY001007No physician or other licensed health care provider order for this item or      No md order for item/service                                                                                                              C                                      2003010120030101        N                           
   EY002008service                                                                                                                                                                                                                                                                                                              
   F1001007Left hand, second digit                                                         Left hand, second digit                                                                                                                   C                                      1995010119990101        N                           
   F2001007Left hand, third digit                                                          Left hand, third digit                                                                                                                    C                                      1995010119990101        N                           
   F3001007Left hand, fourth digit                                                         Left hand, fourth digit                                                                                                                   C                                      1995010119990101        N                           
   F4001007Left hand, fifth digit                                                          Left hand, fifth digit                                                                                                                    C                                      1995010119990101        N                           
   F5001007Right hand, thumb                                                               Right hand, thumb                                                                                                                         C                                      1995010119990101        N                           
   F6001007Right hand, second digit                                                        Right hand, second digit                                                                                                                  C                                      1995010119990101        N                           
   F7001007Right hand, third digit                                                         Right hand, third digit                                                                                                                   C                                      1995010119990101        N                           
   F8001007Right hand, fourth digit                                                        Right hand, fourth digit                                                                                                                  C                                      1995010119990101        N                           
   F9001007Right hand, fifth digit                                                         Right hand, fifth digit                                                                                                                   C                                      1995010119990101        N                           
   FA001007Left hand, thumb                                                                Left hand, thumb                                                                                                                          C                                      1995010119990101        N                           
   FB001007Item provided without cost to provider, supplier or practitioner, or full       Item provided without cost                                                                                                                I                                      2006010120080101        N                           
   FB002008credit received for replaced device (examples, but not limited to, covered                                                                                                                                                                                                                                           
   FB003008under warranty, replaced due to defect, free samples)                                                                                                                                                                                                                                                                
   FC001007Partial credit received for replaced device                                     Part credit, replaced device                                                                                                              D                      0143            2008010120080101        N                           
   FP001007Service provided as part of family planning program                             Svc part of family plan pgm                                                                                                               C                                      1987010120050101        N                           
   FX001007X-ray taken using film                                                          X-ray taken using film                                                                                                                    C                                      2017010120170101        N                           
   FY001007X-ray taken using computed radiography technology/cassette-based imaging        Computed radiography x-ray                                                                                                                C                                      2018010120180101        N                           
   G0001007Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an  Telestroke                                                                                                                                C                                      2019010120190101        A                           
   G0002008acute stroke                                                                                                                                                                                                                                                                                                         
   G1001007Most recent urr reading of less than 60                                         Urr reading of less than 60                                                                                                               C                                      1997010119980101        N                           
   G2001007Most recent urr reading of 60 to 64.9                                           Urr reading of 60 to 64.9                                                                                                                 C                                      1997010119980101        N                           
   G3001007Most recent urr reading of 65 to 69.9                                           Urr  reading of 65 to 69.9                                                                                                                C                                      1997010119980101        N                           
   G4001007Most recent urr reading of 70 to 74.9                                           Urr reading of 70 to 74.9                                                                                                                 C                                      1997010119970101        N                           
   G5001007Most recent urr reading of 75 or greater                                        Urr reading of 75 or greater                                                                                                              C                                      1997010119980101        N                           
   G6001007Esrd patient for whom less than six dialysis sessions have been provided in a   Esrd patient <6 dialysis/mth                                                                                                              C                                      1998050119980501        N                           
   G6002008month                                                                                                                                                                                                                                                                                                                
   G7001007Pregnancy resulted from rape or incest or pregnancy certified by physician as   Payment limits do not apply          35-99             2005.1                                                                             D                      0084            1999070119990701        N                           
   G7002008life threatening                                                                                                                                                                                                                                                                                                     
   G8001007Monitored anesthesia care (mac) for deep complex, complicated, or markedly      Monitored anesthesia care                                                                                                                 C                      0083            1999070119990701        N                           
   G8002008invasive surgical procedure                                                                                                                                                                                                                                                                                          
   G9001007Monitored anesthesia care for patient who has history of severe                 Mac for at risk patient                                                                                                                   C                                      1999070119990701        N                           
   G9002008cardio-pulmonary condition                                                                                                                                                                                                                                                                                           
   GA001007Waiver of liability statement issued as required by payer policy, individual    Liability waiver ind case                                                                                                                 C                                      1995010120110101        N                           
   GA002008case                                                                                                                                                                                                                                                                                                                 
   GB001007Claim being re-submitted for payment because it is no longer covered under a    Claim resubmitted                                                                                                                         C                                      2002010120020101        N                           
   GB002008global payment demonstration                                                                                                                                                                                                                                                                                         
   GC001007This service has been performed in part by a resident under the direction of a  Resident/teaching phys serv                            3350.5  4116                                                                       D                                      1997010120010101        N                           
   GC002008teaching physician                                                                                                                                                                                                                                                                                                   
   GD001007Units of service exceeds medically unlikely edit value and represents           Unit of service > mue value                                                                                                               C                                      2008010120080101        N                           
   GD002008reasonable and necessary services                                                                                                                                                                                                                                                                                    
   GE001007This service has been performed by a resident without the presence of a         Resident prim care exception                           4116                                                                               D                                      1997010119970101        N                           
   GE002008teaching physician under the primary care exception                                                                                                                                                                                                                                                                  
   GF001007Non-physician (e.g. nurse practitioner (np), certified registered nurse         Nonphysician serv c a hosp                                                                                                                C                                      2003040120030401        N                           
   GF002008anesthetist (crna), certified registered nurse (crn), clinical nurse specialist                                                                                                                                                                                                                                      
   GF003008(cns), physician assistant (pa)) services in a critical access hospital                                                                                                                                                                                                                                              
   GG001007Performance and payment of a screening mammogram and diagnostic mammogram on    Payment screen mam + diagmam                                                                                                              C                                      2002010120020101        N                           
   GG002008the same patient, same day                                                                                                                                                                                                                                                                                           
   GH001007Diagnostic mammogram converted from screening mammogram on same day             Diag mammo to screening mamo                                                                                                              C                                      1998100119981001        N                           
   GJ001007"opt out" physician or practitioner emergency or urgent service                 Opt out provider of er srvc                                                                                                               C                                      1998100119981001        N                           
   GK001007Reasonable and necessary item/service associated with a ga or gz modifier       Actual item/service ordered                                                                                                               C                                      2002010120080101        N                           
   GL001007Medically unnecessary upgrade provided instead of non-upgraded item, no charge, Upgraded item, no charge                                                                                                                  C                                      2002010120080101        N                           
   GL002008no advance beneficiary notice (abn)                                                                                                                                                                                                                                                                                  
   GM001007Multiple patients on one ambulance trip                                         Multiple transports                                                                                                                       C                                      2002010120020101        N                           
   GN001007Services delivered under an outpatient speech language pathology plan of care   Op speech language service                                                                                                                C                                      1999010120030101        N                           
   GO001007Services delivered under an outpatient occupational therapy plan of care        Op occupational therapy serv                                                                                                              C                                      1999010120030101        N                           
   GP001007Services delivered under an outpatient physical therapy plan of care            Op pt services                                                                                                                            C                                      1999010120030101        N                           
   GQ001007Via asynchronous telecommunications system                                      Telehealth store and forward                                                                                                              C                                      2001100120011001        N                           
   GR001007This service was performed in whole or in part by a resident in a department of Service by va resident                                                                                                                    C                                      2006010120060101        N                           
   GR002008veterans affairs medical center or clinic, supervised in accordance with va                                                                                                                                                                                                                                          
   GR003008policy                                                                                                                                                                                                                                                                                                               
   GS001007Dosage of erythropoietin stimulating agent has been reduced and maintained in   Epo/darbepoietin reduced 25%                           4273.1                                                                             D                                      2006010120130101        N                           
   GS002008response to hematocrit or hemoglobin level                                                                                                                                                                                                                                                                           
   GT001007Via interactive audio and video telecommunication systems                       Interactivetelecommunication                                                                                                              D                      0073            1999010119990101        N                           
   GU001007Waiver of liability statement issued as required by payer policy, routine noticeLiability waiver rout notice                                                                                                              C                                      2011010120110101        N                           
   GV001007Attending physician not employed or paid under arrangement by the patient's     Attending phys not hospice                             4175-5                                                                             D                                      2002010120020101        N                           
   GV002008hospice provider                                                                                                                                                                                                                                                                                                     
   GW001007Service not related to the hospice patient's terminal condition                 Service unrelated to term co                           4175-5                                                                             D                                      2002010120020101        N                           
   GX001007Notice of liability issued, voluntary under payer policy                        Voluntary liability notice                                                                                                                C                                      2010040120100401        N                           
   GY001007Item or service statutorily excluded, does not meet the definition of any       Statutorily excluded                                                                                                                      S                                      2002010120070701        N                           
   GY002008medicare benefit or, for non-medicare insurers, is not a contract benefit                                                                                                                                                                                                                                            
   GZ001007Item or service expected to be denied as not reasonable and necessary           Not reasonable and necessary                           2000                                                                               M                                      2002010120020101        N                           
   H9001007Court-ordered                                                                   Court-ordered                                                                                                                             I                                      2003010120030101        N                           
   HA001007Child/adolescent program                                                        Child/adolescent program                                                                                                                  I                                      2003010120030101        N                           
   HB001007Adult program, non geriatric                                                    Adult program non-geriatric                                                                                                               I                                      2003010120030101        N                           
   HC001007Adult program, geriatric                                                        Adult program geriatric                                                                                                                   I                                      2003010120030101        N                           
   HD001007Pregnant/parenting women's program                                              Pregnant/parenting program                                                                                                                I                                      2003010120030101        N                           
   HE001007Mental health program                                                           Mental health program                                                                                                                     I                                      2003010120030101        N                           
   HF001007Substance abuse program                                                         Substance abuse program                                                                                                                   I                                      2003010120030101        N                           
   HG001007Opioid addiction treatment program                                              Opioid addiction tx program                                                                                                               I                                      2003010120030101        N                           
   HH001007Integrated mental health/substance abuse program                                Mental hlth/substance abs pr                                                                                                              I                                      2003010120030101        N                           
   HI001007Integrated mental health and intellectual disability/developmental disabilities Men hlth intel/dev disab pgm                                                                                                              I                                      2003010120140101        N                           
   HI002008program                                                                                                                                                                                                                                                                                                              
   HJ001007Employee assistance program                                                     Employee assistance program                                                                                                               I                                      2003010120030101        N                           
   HK001007Specialized mental health programs for high-risk populations                    Spec hgh rsk mntl hlth pop p                                                                                                              I                                      2003010120030101        N                           
   HL001007Intern                                                                          Intern                                                                                                                                    I                                      2003010120030101        N                           
   HM001007Less than bachelor degree level                                                 Less than bachelor degree lv                                                                                                              I                                      2003010120030101        N                           
   HN001007Bachelors degree level                                                          Bachelors degree level                                                                                                                    I                                      2003010120030101        N                           
   HO001007Masters degree level                                                            Masters degree level                                                                                                                      I                                      2003010120030101        N                           
   HP001007Doctoral level                                                                  Doctoral level                                                                                                                            I                                      2003010120030101        N                           
   HQ001007Group setting                                                                   Group setting                                                                                                                             I                                      2003010120030101        N                           
   HR001007Family/couple with client present                                               Family/couple w client prsnt                                                                                                              I                                      2003010120030101        N                           
   HS001007Family/couple without client present                                            Family/couple w/o client prs                                                                                                              I                                      2003010120030101        N                           
   HT001007Multi-disciplinary team                                                         Multi-disciplinary team                                                                                                                   I                                      2003010120030101        N                           
   HU001007Funded by child welfare agency                                                  Child welfare agency funded                                                                                                               I                                      2003010120030101        N                           
   HV001007Funded state addictions agency                                                  Funded state addiction agncy                                                                                                              I                                      2003010120030101        N                           
   HW001007Funded by state mental health agency                                            State mntl hlth agncy funded                                                                                                              I                                      2003010120030101        N                           
   HX001007Funded by county/local agency                                                   County/local agency funded                                                                                                                I                                      2003010120030101        N                           
   HY001007Funded by juvenile justice agency                                               Funded by juvenile justice                                                                                                                I                                      2003010120030101        N                           
   HZ001007Funded by criminal justice agency                                               Criminal justice agncy fund                                                                                                               I                                      2003010120030101        N                           
   J1001007Competitive acquisition program no-pay submission for a prescription number     Cap no-pay for prescript num                                                                                                              C                                      2006010120060101        N                           
   J2001007Competitive acquisition program, restocking of emergency drugs after emergency  Cap restock of emerg drugs                                                                                                                C                                      2006010120060101        N                           
   J2002008administration                                                                                                                                                                                                                                                                                                       
   J3001007Competitive acquisition program (cap), drug not available through cap as        Cap drug unavail thru cap                                                                                                                 C                                      2006010120060101        N                           
   J3002008written, reimbursed under average sales price methodology                                                                                                                                                                                                                                                            
   J4001007Dmepos item subject to dmepos competitive bidding program that is furnished by  Dmepos comp bid furn by hosp                                                                                                              C                                      2010010120100101        N                           
   J4002008a hospital upon discharge                                                                                                                                                                                                                                                                                            
   JA001007Administered intravenously                                                      Administered intravenously                                                                                                                C                                      2007010120070101        N                           
   JB001007Administered subcutaneously                                                     Administered subcutaneously                                                                                                               C                                      2007010120070101        N                           
   JC001007Skin substitute used as a graft                                                 Skin substitute graft                                                                                                                     C                                      2009010120090101        N                           
   JD001007Skin substitute not used as a graft                                             Skin sub not used as a graft                                                                                                              C                                      2009010120090101        N                           
   JE001007Administered via dialysate                                                      Administered via dialysate                                                                                                                C                                      2013070120130701        N                           
   JF001007Compounded drug                                                                 Compounded drug                                                                                                                           C                                      201504012015070120150630N                           
   JG001007Drug or biological acquired with 340b drug pricing program discount             340b acquired drug                                                                                                                        C                                      2018010120180101        N                           
   JW001007Drug amount discarded/not administered to any patient                           Discarded drug not administe                                                                                                              C                                      2003010120030101        N                           
   K0001007Lower extremity prosthesis functional level 0 - does not have the ability or    Lwr ext prost functnl lvl 0                                                                                                               C                                      1993010120030101        N                           
   K0002008potential to ambulate or transfer safely with or without assistance and a                                                                                                                                                                                                                                            
   K0003008prosthesis does not enhance their quality of life or mobility.                                                                                                                                                                                                                                                       
   K1001007Lower extremity prosthesis functional level 1 - has the ability or potential to Lwr ext prost functnl lvl 1                                                                                                               C                                      1993010119970101        N                           
   K1002008use a prosthesis for transfers or ambulation on level surfaces at fixed                                                                                                                                                                                                                                              
   K1003008cadence. typical of the limited and unlimited household ambulator.                                                                                                                                                                                                                                                   
   K2001007Lower extremity prosthesis functional level 2 - has the ability or potential    Lwr ext prost functnl lvl 2                                                                                                               C                                      1993010119970101        N                           
   K2002008for ambulation with the ability to traverse low level environmental barriers                                                                                                                                                                                                                                         
   K2003008such as curbs, stairs or uneven surfaces.  typical of the limited community                                                                                                                                                                                                                                          
   K2004008ambulator.                                                                                                                                                                                                                                                                                                           
   K3001007Lower extremity prosthesis functional level 3 - has the ability or potential    Lwr ext prost functnl lvl 3                                                                                                               C                                      1993010119970101        N                           
   K3002008for ambulation with variable cadence.  typical of the community ambulator who                                                                                                                                                                                                                                        
   K3003008has the ability to transverse most environmental barriers and may have                                                                                                                                                                                                                                               
   K3004008vocational, therapeutic, or exercise activity that demands prosthetic                                                                                                                                                                                                                                                
   K3005008utilization beyond simple locomotion.                                                                                                                                                                                                                                                                                
   K4001007Lower extremity prosthesis functional level 4 - has the ability or potential    Lwr ext prost functnl lvl 4                                                                                                               C                                      1993010119970101        N                           
   K4002008for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting                                                                                                                                                                                                                                       
   K4003008high impact, stress, or energy levels, typical of the prosthetic demands of the                                                                                                                                                                                                                                      
   K4004008child, active adult, or athlete.                                                                                                                                                                                                                                                                                     
   KA001007Add on option/accessory for wheelchair                                          Wheelchair add-on option/acc                                                                                                              C                                      1994010119970101        N                           
   KB001007Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim>4 modifiers on claim                                                                                                                     C                                      2003010120030101        N                           
   KC001007Replacement of special power wheelchair interface                               Repl special pwr wc intrface                                                                                                              C                                      2005010120050101        N                           
   KD001007Drug or biological infused through dme                                          Drug/biological dme infused                                                                                                               C                                      2004010120040101        N                           
   KE001007Bid under round one of the dmepos competitive bidding program for use with      Bid under round 1 dmepos cb                                                                                                               C                                      2009010120090101        N                           
   KE002008non-competitive bid base equipment                                                                                                                                                                                                                                                                                   
   KF001007Item designated by fda as class iii device                                      Fda class iii device                                                                                                                      C                                      2004040120040401        N                           
   KG001007Dmepos item subject to dmepos competitive bidding program number 1              Dmepos comp bid prgm no 1                                                                                                                 C                                      2007070120070701        N                           
   KH001007Dmepos item, initial claim, purchase or first month rental                      Dmepos ini clm, pur/1 mo rnt                                                                                                              C                                      1994010119970101        N                           
   KI001007Dmepos item, second or third month rental                                       Dmepos 2nd or 3rd mo rental                                                                                                               C                                      1994010119970101        N                           
   KJ001007Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months   Dmepos pen pmp or 4-15mo rnt                                                                                                              C                                      1994010119970101        N                           
   KJ002008four to fifteen                                                                                                                                                                                                                                                                                                      
   KK001007Dmepos item subject to dmepos competitive bidding program number 2              Dmepos comp bid prgm no 2                                                                                                                 C                                      2007070120070701        N                           
   KL001007Dmepos item delivered via mail                                                  Dmepos mailorder comp bid                                                                                                                 C                                      2007070120090101        N                           
   KM001007Replacement of facial prosthesis including new impression/moulage               Rplc facial prosth new imp                                                                                                                C                                      1996010120010101        N                           
   KN001007Replacement of facial prosthesis using previous master model                    Rplc facial prosth old mod                                                                                                                C                                      1996010120010101        N                           
   KO001007Single drug unit dose formulation                                               Single drug unit dose form                                                                                                                C                                      1997040119970401        N                           
   KP001007First drug of a multiple drug unit dose formulation                             First drug of multi drug u d                                                                                                              C                                      1997040119970401        N                           
   KQ001007Second or subsequent drug of a multiple drug unit dose formulation              2nd/subsqnt drg multi drg ud                                                                                                              C                                      1997040119970401        N                           
   KR001007Rental item, billing for partial month                                          Rental item partial month                                                                                                                 C                                      2002010120020101        N                           
   KS001007Glucose monitor supply for diabetic beneficiary not treated with insulin        Glucose monitor supply                                                                                                                    D                      0074            1998100119981001        N                           
   KT001007Beneficiary resides in a competitive bidding area and travels outside that      Item from noncontract supply                                                                                                              C                                      2007070120080401        N                           
   KT002008competitive bidding area and receives a competitive bid item                                                                                                                                                                                                                                                         
   KU001007Dmepos item subject to dmepos competitive bidding program number 3              Dmepos comp bid prgm no 3                                                                                                                 C                                      2007070120070701        N                           
   KV001007Dmepos item subject to dmepos competitive bidding program that is furnished as  Dmepos item, profession serv                                                                                                              C                                      2008010120080101        N                           
   KV002008part of a professional service                                                                                                                                                                                                                                                                                       
   KW001007Dmepos item subject to dmepos competitive bidding program number 4              Dmepos comp bid prgm no 4                                                                                                                 C                                      2008010120080101        N                           
   KX001007Requirements specified in the medical policy have been met                      Documentation on file                                                                                                                     C                                      2002070120020701        N                           
   KY001007Dmepos item subject to dmepos competitive bidding program number 5              Dmepos comp bid prgm no 5                                                                                                                 C                                      2008010120080101        N                           
   KZ001007New coverage not implemented by managed care                                    New cov not implement by m+c                                                                                                              C                                      2003100120031001        N                           
   L1001007Provider attestation that the hospital laboratory test(s) is not packaged under Separately payable lab test                                                                                                               C                                      201407012017010120161231N                           
   L1002008the hospital opps                                                                                                                                                                                                                                                                                                    
   LC001007Left circumflex coronary artery                                                 Lft circum coronary artery                                                                                                                C                                      1997010119970101        N                           
   LD001007Left anterior descending coronary artery                                        Left ant des coronary artery                                                                                                              C                                      1997010119970101        N                           
   LL001007Lease/rental (use the 'll' modifier when dme equipment rental is to be applied  Lease/rental (appld to pur)                                                                                                               C                                      1984010119970101        N                           
   LL002008against the purchase price)                                                                                                                                                                                                                                                                                          
   LM001007Left main coronary artery                                                       Left main coronary artery                                                                                                                 C                                      2013010120130101        N                           
   LR001007Laboratory round trip                                                           Laboratory round trip                                                                                                                     C                                      1987010119970101        N                           
   LS001007Fda-monitored intraocular lens implant                                          Fda-monitored iol implant            65-7                                                                                                 D                                      1991010119970101        N                           
   LT001007Left side (used to identify procedures performed on the left side of the body)  Left side                                                                                                                                 C                                      1984010119970101        N                           
   M2001007Medicare secondary payer (msp)                                                  Medicare secondary payer                                                                                                                  C                                      2007010120070101        N                           
   MS001007Six month maintenance and servicing fee for reasonable and necessary parts and  6-mo maint/svc fee parts/lbr                                                                                                              C                                      1989010119970101        N                           
   MS002008labor which are not covered under any manufacturer or supplier warranty                                                                                                                                                                                                                                              
   NB001007Nebulizer system, any type, fda-cleared for use with specific drug              Drug specific nebulizer                                                                                                                   C                                      2011010120110101        N                           
   NR001007New when rented (use the 'nr' modifier when dme which was new at the time of    New when rented                                                                                                                           C                                      1984010119970101        N                           
   NR002008rental is subsequently purchased)                                                                                                                                                                                                                                                                                    
   NU001007New equipment                                                                   New equipment                                                                                                                             C                                      1984010119970101        N                           
   P1001007A normal healthy patient                                                        Normal healthy patient                                                                                                                    C                                      2006010120060101        N                           
   P2001007A patient with mild systemic disease                                            Patient w/mild syst disease                                                                                                               C                                      2006010120060101        N                           
   P3001007A patient with severe systemic disease                                          Patient w/severe sys disease                                                                                                              C                                      2006010120060101        N                           
   P4001007A patient with severe systemic disease that is a constant threat to life        Pt w/sev sys dis threat life                                                                                                              C                                      2006010120060101        N                           
   P5001007A moribund patient who is not expected to survive without the operation         Pt not expect surv w/o oper                                                                                                               C                                      2006010120060101        N                           
   P6001007A declared brain-dead patient whose organs are being removed for donor purposes Brain-dead pt organs removed                                                                                                              C                                      2006010120060101        N                           
   PA001007Surgical or other invasive procedure on wrong body part                         Surgery, wrong body part                                                                                                                  I                                      2009070120090701        N                           
   PB001007Surgical or other invasive procedure on wrong patient                           Surgery, wrong patient                                                                                                                    I                                      2009070120090701        N                           
   PC001007Wrong surgery or other invasive procedure on patient                            Wrong surgery on patient                                                                                                                  I                                      2009070120090701        N                           
   PD001007Diagnostic or related non diagnostic item or service provided in a wholly owned Inp admit w/in 3 days                                                                                                                     C                                      2012010120120101        N                           
   PD002008or operated entity to a patient who is admitted as an inpatient within 3 days                                                                                                                                                                                                                                        
   PI001007Positron emission tomography (pet) or pet/computed tomography (ct) to inform    Pet tumor init tx strat                                                                                                                   C                                      2009070120090701        N                           
   PI002008the initial treatment strategy of tumors that are biopsy proven or strongly                                                                                                                                                                                                                                          
   PI003008suspected of being cancerous based on other diagnostic testing                                                                                                                                                                                                                                                       
   PL001007Progressive addition lenses                                                     Progressive addition lenses                                                                                                               C                                      1989010119970101        N                           
   PM001007Post mortem                                                                     Post mortem                                                                                                                               C                                      2014010120140101        N                           
   PN001007Non-excepted service provided at an off-campus, outpatient, provider-based      Non-excepted off-campus svc                                                                                                               C                      0207            2017010120170101        N                           
   PN002008department of a hospital                                                                                                                                                                                                                                                                                             
   PO001007Excepted service provided at an off-campus, outpatient, provider-based          Excepted off-campus service                                                                                                               C                      0207            2015010120170101        N                           
   PO002008department of a hospital                                                                                                                                                                                                                                                                                             
   PS001007Positron emission tomography (pet) or pet/computed tomography (ct) to inform    Pet tumor subsq tx strategy                                                                                                               C                                      2009070120090701        N                           
   PS002008the subsequent treatment strategy of cancerous tumors when the beneficiary's                                                                                                                                                                                                                                         
   PS003008treating physician determines that the pet study is needed to inform subsequent                                                                                                                                                                                                                                      
   PS004008anti-tumor strategy                                                                                                                                                                                                                                                                                                  
   PT001007Colorectal cancer screening test; converted to diagnostic test or other         Clrctal screen to diagn                                                                                                                   C                                      2011010120110101        N                           
   PT002008procedure                                                                                                                                                                                                                                                                                                            
   Q0001007Investigational clinical service provided in a clinical research study that is  Invest clinical research                                                                                                                  D                      0146            2008010120080101        N                           
   Q0002008in an approved clinical research study                                                                                                                                                                                                                                                                               
   Q1001007Routine clinical service provided in a clinical research study that is in an    Routine clinical research                                                                                                                 D                      0146            2008010120080101        N                           
   Q1002008approved clinical research study                                                                                                                                                                                                                                                                                     
   Q2001007Demonstration procedure/service                                                 Demo procedure, service                                                                                                                   C                      0046            1992010120170101        N                           
   Q3001007Live kidney donor surgery and related services                                  Live donor surgery/services                                                                                                               C                                      1995010120030101        N                           
   Q4001007Service for ordering/referring physician qualifies as a service exemption       Svc exempt - ordrg/rfrng md                                                                                                               C                                      1994010119970101        N                           
   Q5001007Service furnished under a reciprocal billing arrangement by a substitute        Recip bill arr subs md or pt                           3060.6                                                                             D                                      1993010120170701        N                           
   Q5002008physician or by a substitute physical therapist furnishing outpatient physical                                                                                                                                                                                                                                       
   Q5003008therapy services in a health professional shortage area, a medically                                                                                                                                                                                                                                                 
   Q5004008underserved area, or a rural area                                                                                                                                                                                                                                                                                    
   Q6001007Service furnished under a fee-for-time compensation arrangement by a substitute Fee/time comp subst md or pt                           3060.7                                                                             D                                      1993010120170701        N                           
   Q6002008physician or by a substitute physical therapist furnishing outpatient physical                                                                                                                                                                                                                                       
   Q6003008therapy services in a health professional shortage area, a medically                                                                                                                                                                                                                                                 
   Q6004008underserved area, or a rural area                                                                                                                                                                                                                                                                                    
   Q7001007One class a finding                                                             One class a finding                                                                                                                       C                                      1995010119970101        N                           
   Q8001007Two class b findings                                                            Two class b findings                                                                                                                      C                                      1995010119970101        N                           
   Q9001007One class b and two class c findings                                            1 class b & 2 class c fndngs                                                                                                              C                                      1995010119970101        N                           
   QA001007Prescribed amounts of stationary oxygen for daytime use while at rest and       Avg sta day/night o2 < 1 lpm                                                                                                              C                                      2018040120180401        A                           
   QA002008nighttime use differ and the average of the two amounts is less than 1 liter                                                                                                                                                                                                                                         
   QA003008per minute (lpm)                                                                                                                                                                                                                                                                                                     
   QB001007Prescribed amounts of stationary oxygen for daytime use while at rest and       Avg day/nite o2 > 4 lpm/port                                                                                                              C                                      2018040120180401        A                           
   QB002008nighttime use differ and the average of the two amounts exceeds 4 liters per                                                                                                                                                                                                                                         
   QB003008minute (lpm) and portable oxygen is prescribed                                                                                                                                                                                                                                                                       
   QC001007Single channel monitoring                                                       Single channel monitoring                                                                                                                 C                                      1989010119970101        N                           
   QD001007Recording and storage in solid state memory by a digital recorder               Rcrdg/strg in sld st memory                                                                                                               C                                      1989010119970101        N                           
   QE001007Prescribed amount of stationary oxygen while at rest is less than 1 liter per   Stationary o2 @ rest <1 lpm                                                                                                               C                                      1989010120180401        C                           
   QE002008minute (lpm)                                                                                                                                                                                                                                                                                                         
   QF001007Prescribed amount of stationary oxygen while at rest exceeds 4 liters per       Station o2 @ rest >4lpm/port                                                                                                              C                                      1989010120180401        C                           
   QF002008minute (lpm) and portable oxygen is prescribed                                                                                                                                                                                                                                                                       
   QG001007Prescribed amount of stationary oxygen while at rest is greater than 4 liters   Station o2 @ rest > 4 lpm                                                                                                                 C                                      1989010120180401        C                           
   QG002008per minute (lpm)                                                                                                                                                                                                                                                                                                     
   QH001007Oxygen conserving device is being used with an oxygen delivery system           Oxygen cnsrvg dvc w del sys                                                                                                               C                                      1989010119970101        N                           
   QJ001007Services/items provided to a prisoner or patient in state or local custody,     Patient in state/locl custod                                                                                                              D                      0111            2003010120030101        N                           
   QJ002008however the state or local government, as applicable, meets the requirements in                                                                                                                                                                                                                                      
   QJ00300842 cfr 411.4 (b)                                                                                                                                                                                                                                                                                                     
   QK001007Medical direction of two, three, or four concurrent anesthesia procedures       Med dir 2-4 cncrnt anes proc                           3350.5                                                                             D                                      1995010120010101        N                           
   QK002008involving qualified individuals                                                                                                                                                                                                                                                                                      
   QL001007Patient pronounced dead after ambulance called                                  Patient died after amb call                                                                                                               C                                      1999010119990101        N                           
   QM001007Ambulance service provided under arrangement by a provider of services          Ambulance arr by provider                                                                                                                 C                                      1996010119990101        N                           
   QN001007Ambulance service furnished directly by a provider of services                  Ambulance furn by provider                                                                                                                C                                      1996010119990101        N                           
   QP001007Documentation is on file showing that the laboratory test(s) was ordered        Individually ordered lab tst                           7517.1                                                                             D                                      1996010119960301        N                           
   QP002008individually or ordered as a cpt-recognized panel other than automated profile                                                                                                                                                                                                                                       
   QP003008codes 80002-80019, g0058, g0059, and g0060.                                                                                                                                                                                                                                                                          
   QQ001007Ordering professional consulted a qualified clinical decision support mechanism Qualified cdsm consulted                                                                                                                  C                                      2018070120180701        A                           
   QQ002008for this service and the related data was provided to the furnishing                                                                                                                                                                                                                                                 
   QQ003008professional                                                                                                                                                                                                                                                                                                         
   QR001007Prescribed amounts of stationary oxygen for daytime use while at rest and       Avg sta day/night o2 > 4 lpm                                                                                                              C                                      2018040120180401        A                           
   QR002008nighttime use differ and the average of the two amounts is greater than 4                                                                                                                                                                                                                                            
   QR003008liters per minute (lpm)                                                                                                                                                                                                                                                                                              
   QS001007Monitored anesthesia care service                                               Monitored anesthesia care            15018I                                                                                               D                                      1990010119960701        N                           
   QT001007Recording and storage on tape by an analog tape recorder                        Rcrdg/strg tape analog recdr                                                                                                              C                                      1989010119970101        N                           
   QW001007Clia waived test                                                                Clia waived test                                                                                                                          C                                      1996010119961001        N                           
   QX001007Crna service: with medical direction by a physician                             Crna svc w/ md med direction                                                                                                              C                                      1993010119970101        N                           
   QY001007Medical direction of one certified registered nurse anesthetist (crna) by an    Medically directed crna                                3350.5                                                                             D                                      1998010120010101        N                           
   QY002008anesthesiologist                                                                                                                                                                                                                                                                                                     
   QZ001007Crna service: without medical direction by a physician                          Crna svc w/o med dir by md                                                                                                                C                                      1993010119970101        N                           
   RA001007Replacement of a dme, orthotic or prosthetic item                               Replacement of dme item                                                                                                                   C                                      2009010120110101        N                           
   RB001007Replacement of a part of a dme, orthotic or prosthetic item furnished as part   Replacement part, dme item                                                                                                                C                                      2009010120110101        N                           
   RB002008of a repair                                                                                                                                                                                                                                                                                                          
   RC001007Right coronary artery                                                           Right coronary artery                                                                                                                     C                                      1997010119970101        N                           
   RD001007Drug provided to beneficiary, but not administered "incident-to"                Drug admin not incident-to                                                                                                                C                                      2004010120040101        N                           
   RE001007Furnished in full compliance with fda-mandated risk evaluation and mitigation   Furnish full compliance rems                                                                                                              C                                      2009010120090101        N                           
   RE002008strategy (rems)                                                                                                                                                                                                                                                                                                      
   RI001007Ramus intermedius coronary artery                                               Ramus intermedius cor artery                                                                                                              C                                      2013010120130101        N                           
   RR001007Rental (use the 'rr' modifier when dme is to be rented)                         Rental (dme)                                                                                                                              C                                      1984010119970101        N                           
   RT001007Right side (used to identify procedures performed on the right side of the body)Right side                                                                                                                                C                                      1984010119970101        N                           
   SA001007Nurse practitioner rendering service in collaboration with a physician          Nurse practitioner w physici                                                                                                              I                                      2001070120010701        N                           
   SB001007Nurse midwife                                                                   Nurse midwife                                                                                                                             I                                      2001070120010701        N                           
   SC001007Medically necessary service or supply                                           Medically necessary serv/sup                                                                                                              C                                      2001070120110401        N                           
   SD001007Services provided by registered nurse with specialized, highly technical home   Serv by home infusion rn                                                                                                                  I                                      2001070120010701        N                           
   SD002008infusion training                                                                                                                                                                                                                                                                                                    
   SE001007State and/or federally-funded programs/services                                 State/fed funded program/ser                                                                                                              I                                      2001070120010701        N                           
   SF001007Second opinion ordered by a professional review organization (pro) per section  2nd opinion ordered by pro                                                                                                                C                                      1987010119970101        N                           
   SF0020089401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance)                                                                                                                                                                                                                                       
   SG001007Ambulatory surgical center (asc) facility service                               Asc facility service                                                                                                                      C                                      1992010119970101        N                           
   SH001007Second concurrently administered infusion therapy                               2nd concurrent infusion ther                                                                                                              I                                      2001070120010701        N                           
   SJ001007Third or more concurrently administered infusion therapy                        3rd concurrent infusion ther                                                                                                              I                                      2001070120010701        N                           
   SK001007Member of high risk population (use only with codes for immunization)           High risk population                                                                                                                      I                                      2002040120020401        N                           
   SL001007State supplied vaccine                                                          State supplied vaccine                                                                                                                    I                                      2002040120020401        N                           
   SM001007Second surgical opinion                                                         Second opinion                                                                                                                            I                                      2002070120020701        N                           
   SN001007Third surgical opinion                                                          Third opinion                                                                                                                             I                                      2002070120020701        N                           
   SQ001007Item ordered by home health                                                     Item ordered by home health                                                                                                               I                                      2002100120021001        N                           
   SS001007Home infusion services provided in the infusion suite of the iv therapy providerHit in infusion suite                                                                                                                     I                                      2004100120041001        N                           
   ST001007Related to trauma or injury                                                     Related to trauma or injury                                                                                                               I                                      2003010120030101        N                           
   SU001007Procedure performed in physician's office (to denote use of facility and        Performed in phys office                                                                                                                  I                                      2003010120030101        N                           
   SU002008equipment)                                                                                                                                                                                                                                                                                                           
   SV001007Pharmaceuticals delivered to patient's home but not utilized                    Drugs delivered not used                                                                                                                  I                                      2003010120030101        N                           
   SW001007Services provided by a certified diabetic educator                              Serv by cert diab educator                                                                                                                C                                      2004040120040401        N                           
   SY001007Persons who are in close contact with member of high-risk population (use only  Contact w/high-risk pop                                                                                                                   I                                      2005010120050101        N                           
   SY002008with codes for immunization)                                                                                                                                                                                                                                                                                         
   SZ001007Habilitative services                                                           Habilitative services                                                                                                                     C                                      201407012018010120171231N                           
   T1001007Left foot, second digit                                                         Left foot, second digit                                                                                                                   C                                      1995010119990101        N                           
   T2001007Left foot, third digit                                                          Left foot, third digit                                                                                                                    C                                      1995010119990101        N                           
   T3001007Left foot, fourth digit                                                         Left foot, fourth digit                                                                                                                   C                                      1995010119990101        N                           
   T4001007Left foot, fifth digit                                                          Left foot, fifth digit                                                                                                                    C                                      1995010119990101        N                           
   T5001007Right foot, great toe                                                           Right foot, great toe                                                                                                                     C                                      1995010119990101        N                           
   T6001007Right foot, second digit                                                        Right foot, second digit                                                                                                                  C                                      1995010119990101        N                           
   T7001007Right foot, third digit                                                         Right foot, third digit                                                                                                                   C                                      1995010119990101        N                           
   T8001007Right foot, fourth digit                                                        Right foot, fourth digit                                                                                                                  C                                      1995010119990101        N                           
   T9001007Right foot, fifth digit                                                         Right foot, fifth digit                                                                                                                   C                                      1995010119990101        N                           
   TA001007Left foot, great toe                                                            Left foot, great toe                                                                                                                      C                                      1995010119990101        N                           
   TB001007Drug or biological acquired with 340b drug pricing program discount, reported   Tracking 340b acquired drug                                                                                                               C                                      2018010120180101        N                           
   TB002008for informational purposes                                                                                                                                                                                                                                                                                           
   TC001007Technical component; under certain circumstances, a charge may be made for the  Technical component                                                                                                                       C                                      1984010119970101        N                           
   TC002008technical component alone;  under those circumstances the technical component                                                                                                                                                                                                                                        
   TC003008charge is identified by adding modifier 'tc' to the usual procedure number;                                                                                                                                                                                                                                          
   TC004008technical component charges are institutional charges and not billed separately                                                                                                                                                                                                                                      
   TC005008by physicians; however, portable x-ray suppliers only bill for technical                                                                                                                                                                                                                                             
   TC006008component and should utilize modifier tc; the charge data from portable x-ray                                                                                                                                                                                                                                        
   TC007008suppliers will then be used to build customary and prevailing profiles                                                                                                                                                                                                                                               
   TD001007Rn                                                                              Rn                                                                                                                                        I                                      2001070120010701        N                           
   TE001007Lpn/lvn                                                                         Lpn/lvn                                                                                                                                   I                                      2001070120010701        N                           
   TF001007Intermediate level of care                                                      Intermediate level of care                                                                                                                I                                      2001070120010701        N                           
   TG001007Complex/high tech level of care                                                 Complex/high tech level care                                                                                                              I                                      2001070120010701        N                           
   TH001007Obstetrical treatment/services, prenatal or postpartum                          Ob tx/srvcs prenatl/postpart                                                                                                              I                                      2001070120010701        N                           
   TJ001007Program group, child and/or adolescent                                          Child/adolescent program gp                                                                                                               I                                      2001070120010701        N                           
   TK001007Extra patient or passenger, non-ambulance                                       Extra patient or passenger                                                                                                                I                                      2002040120020401        N                           
   TL001007Early intervention/individualized family service plan (ifsp)                    Early intervention ifsp                                                                                                                   I                                      2002040120020401        N                           
   TM001007Individualized education program (iep)                                          Individualized ed prgrm(iep)                                                                                                              I                                      2002040120020401        N                           
   TN001007Rural/outside providers' customary service area                                 Rural/out of service area                                                                                                                 I                                      2002040120020401        N                           
   TP001007Medical transport, unloaded vehicle                                             Med transprt unloaded vehicl                                                                                                              I                                      2002040120020401        N                           
   TQ001007Basic life support transport by a volunteer ambulance provider                  Bls by volunteer amb providr                                                                                                              I                                      2002040120020401        N                           
   TR001007School-based individualized education program (iep) services provided outside   School-based iep out of dist                                                                                                              I                                      2002070120020701        N                           
   TR002008the public school district responsible for the student                                                                                                                                                                                                                                                               
   TS001007Follow-up service                                                               Follow-up service                                                                                                                         C                                      2002100120060101        N                           
   TT001007Individualized service provided to more than one patient in same setting        Additional patient                                                                                                                        I                                      2002100120021001        N                           
   TU001007Special payment rate, overtime                                                  Overtime payment rate                                                                                                                     I                                      2003010120030101        N                           
   TV001007Special payment rates, holidays/weekends                                        Holiday/weekend payment rate                                                                                                              I                                      2003010120030101        N                           
   TW001007Back-up equipment                                                               Back-up equipment                                                                                                                         I                                      2003010120030101        N                           
   U1001007Medicaid level of care 1, as defined by each state                              M/caid care lev 1 state def                                                                                                               I                                      2002070120020701        N                           
   U2001007Medicaid level of care 2, as defined by each state                              M/caid care lev 2 state def                                                                                                               I                                      2002070120020701        N                           
   U3001007Medicaid level of care 3, as defined by each state                              M/caid care lev 3 state def                                                                                                               I                                      2002070120020701        N                           
   U4001007Medicaid level of care 4, as defined by each state                              M/caid care lev 4 state def                                                                                                               I                                      2002070120020701        N                           
   U5001007Medicaid level of care 5, as defined by each state                              M/caid care lev 5 state def                                                                                                               I                                      2002070120020701        N                           
   U6001007Medicaid level of care 6, as defined by each state                              M/caid care lev 6 state def                                                                                                               I                                      2002070120020701        N                           
   U7001007Medicaid level of care 7, as defined by each state                              M/caid care lev 7 state def                                                                                                               I                                      2002070120020701        N                           
   U8001007Medicaid level of care 8, as defined by each state                              M/caid care lev 8 state def                                                                                                               I                                      2002070120020701        N                           
   U9001007Medicaid level of care 9, as defined by each state                              M/caid care lev 9 state def                                                                                                               I                                      2002070120020701        N                           
   UA001007Medicaid level of care 10, as defined by each state                             M/caid care lev 10 state def                                                                                                              I                                      2002070120020701        N                           
   UB001007Medicaid level of care 11, as defined by each state                             M/caid care lev 11 state def                                                                                                              I                                      2002070120020701        N                           
   UC001007Medicaid level of care 12, as defined by each state                             M/caid care lev 12 state def                                                                                                              I                                      2002070120020701        N                           
   UD001007Medicaid level of care 13, as defined by each state                             M/caid care lev 13 state def                                                                                                              I                                      2002070120020701        N                           
   UE001007Used durable medical equipment                                                  Used durable med equipment                                                                                                                C                                      1984010119970101        N                           
   UF001007Services provided in the morning                                                Services provided, morning                                                                                                                I                                      2003040120030401        N                           
   UG001007Services provided in the afternoon                                              Services provided, afternoon                                                                                                              I                                      2003040120030401        N                           
   UH001007Services provided in the evening                                                Services provided, evening                                                                                                                I                                      2003040120030401        N                           
   UJ001007Services provided at night                                                      Services provided, night                                                                                                                  C                                      2003040120170101        N                           
   UK001007Services provided on behalf of the client to someone other than the client      Svc on behalf client-collat                                                                                                               I                                      2003040120030401        N                           
   UK002008(collateral relationship)                                                                                                                                                                                                                                                                                            
   UN001007Two patients served                                                             Two patients served                                                                                                                       C                      0114            2004010120040101        N                           
   UP001007Three patients served                                                           Three patients served                                                                                                                     C                      0114            2004010120040101        N                           
   UQ001007Four patients served                                                            Four patients served                                                                                                                      C                      0114            2004010120040101        N                           
   UR001007Five patients served                                                            Five patients served                                                                                                                      C                      0114            2004010120040101        N                           
   US001007Six or more patients served                                                     Six or more patients served                                                                                                               C                      0114            2004010120040101        N                           
   V1001007Demonstration modifier 1                                                        Demonstration modifier 1                                                                                                                  C                                      2017010120170101        N                           
   V2001007Demonstration modifier 2                                                        Demonstration modifier 2                                                                                                                  C                                      2017010120170101        N                           
   V3001007Demonstration modifier 3                                                        Demonstration modifier 3                                                                                                                  C                                      2017010120170101        N                           
   V5001007Vascular catheter (alone or with any other vascular access)                     Vascular catheter                                                                                                                         C                                      2010010120100701        N                           
   V6001007Arteriovenous graft (or other vascular access not including a vascular catheter)Arteriovenous graft                                                                                                                       C                                      2010010120100701        N                           
   V7001007Arteriovenous fistula only (in use with two needles)                            Arteriovenous fistula                                                                                                                     C                                      2010010120100701        N                           
   V8001007Infection present                                                               Infection present                                                                                                                         C                                      201001012012040120120331N                           
   V9001007No infection present                                                            No infection present                                                                                                                      C                                      201001012012040120120331N                           
   VM001007Medicare diabetes prevention program (mdpp) virtual make-up session             Mdpp virtual make-up session                                                                                                              C                                      2018040120180401        A                           
   VP001007Aphakic patient                                                                 Aphakic patient                                                                                                                           C                                      1984010119970101        N                           
   X1001007Continuous/broad services: for reporting services by clinicians, who provide    Continuous/broad services                                                                                                                 C                                      2018010120180101        N                           
   X1002008the principal care for a patient, with no planned endpoint of the relationship;                                                                                                                                                                                                                                      
   X1003008services in this category represent comprehensive care, dealing with the entire                                                                                                                                                                                                                                      
   X1004008scope of patient problems, either directly or in a care coordination role;                                                                                                                                                                                                                                           
   X1005008reporting clinician service examples include, but are not limited to: primary                                                                                                                                                                                                                                        
   X1006008care, and clinicians providing comprehensive care to patients in addition to                                                                                                                                                                                                                                         
   X1007008specialty care                                                                                                                                                                                                                                                                                                       
   X2001007Continuous/focused services: for reporting services by clinicians whose         Continuous/focused services                                                                                                               C                                      2018010120180101        N                           
   X2002008expertise is needed for the ongoing management of a chronic disease or a                                                                                                                                                                                                                                             
   X2003008condition that needs to be managed and followed with no planned endpoint to the                                                                                                                                                                                                                                      
   X2004008relationship; reporting clinician service examples include but are not limited                                                                                                                                                                                                                                       
   X2005008to: a rheumatologist taking care of the patient's rheumatoid arthritis                                                                                                                                                                                                                                               
   X2006008longitudinally but not providing general primary care services                                                                                                                                                                                                                                                       
   X3001007Episodic/broad servies: for reporting services by clinicians who have broad     Episodic/broad services                                                                                                                   C                                      2018010120180101        N                           
   X3002008responsibility for the comprehensive needs of the patient that is limited to a                                                                                                                                                                                                                                       
   X3003008defined period and circumstance such as a hospitalization; reporting clinician                                                                                                                                                                                                                                       
   X3004008service examples include but are not limited to the hospitalist's services                                                                                                                                                                                                                                           
   X3005008rendered providing comprehensive and general care to a patient while admitted                                                                                                                                                                                                                                        
   X3006008to the hospital                                                                                                                                                                                                                                                                                                      
   X4001007Episodic/focused services: for reporting services by clinicians who provide     Episodic/focused services                                                                                                                 C                                      2018010120180101        N                           
   X4002008focused care on particular types of treatment limited to a defined period and                                                                                                                                                                                                                                        
   X4003008circumstance; the patient has a problem, acute or chronic, that will be treated                                                                                                                                                                                                                                      
   X4004008with surgery, radiation, or some other type of generally time-limited                                                                                                                                                                                                                                                
   X4005008intervention; reporting clinician service examples include but are not limited                                                                                                                                                                                                                                       
   X4006008to, the orthopedic surgeon performing a knee replacement and seeing the patient                                                                                                                                                                                                                                      
   X4007008through the postoperative period                                                                                                                                                                                                                                                                                     
   X5001007Diagnostic services requested by another clinician: for reporting services by a Svc req by another clinician                                                                                                              C                                      2018010120180101        N                           
   X5002008clinician who furnishes care to the patient only as requested by another                                                                                                                                                                                                                                             
   X5003008clinician or subsequent and related services requested by another clinician;                                                                                                                                                                                                                                         
   X5004008this modifier is reported for patient relationships that may not be adequately                                                                                                                                                                                                                                       
   X5005008captured by the above alternative categories; reporting clinician service                                                                                                                                                                                                                                            
   X5006008examples include but are not limited to, the radiologist's interpretation of an                                                                                                                                                                                                                                      
   X5007008imaging study requested by another clinician                                                                                                                                                                                                                                                                         
   XE001007Separate encounter, a service that is distinct because it occurred during a     Separate encounter                                                                                                                        C                                      2015010120150101        N                           
   XE002008separate encounter                                                                                                                                                                                                                                                                                                   
   XP001007Separate practitioner, a service that is distinct because it was performed by a Separate practitioner                                                                                                                     C                                      2015010120150101        N                           
   XP002008different practitioner                                                                                                                                                                                                                                                                                               
   XS001007Separate structure, a service that is distinct because it was performed on a    Separate organ/structure                                                                                                                  C                                      2015010120150101        N                           
   XS002008separate organ/structure                                                                                                                                                                                                                                                                                             
   XU001007Unusual non-overlapping service, the use of a service that is distinct because  Unusual separate service                                                                                                                  C                                      2015010120150101        N                           
   XU002008it does not overlap usual components of the main service                                                                                                                                                                                                                                                             
   ZA001007Novartis/sandoz                                                                 Novartis/sandoz                                                                                                                           C                                      201601012018040120180331D                           
   ZB001007Pfizer/hospira                                                                  Pfizer/hospira                                                                                                                            C                                      201607012018040120180331D                           
   ZC001007Merck/samsung bioepis                                                           Merck/samsung bioepis                                                                                                                     C                                      201710012018040120180331D                           
A0021001003Ambulance service, outside state per mile, transport (medicaid only)            Outside state ambulance serv00      9                                                                            A0030                    I                          O1A D      01985010119960910        N                           
A0080001003Non-emergency transportation, per mile - vehicle provided by volunteer          Noninterest escort in non er00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0080002004(individual or organization), with no vested interest                                                                                                                                                                                                                                                                
A0090001003Non-emergency transportation, per mile - vehicle provided by individual (family Interest escort in non er   00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0090002004member, self, neighbor) with vested interest                                                                                                                                                                                                                                                                         
A0100001003Non-emergency transportation; taxi                                              Nonemergency transport taxi 00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0110001003Non-emergency transportation and bus, intra or inter state carrier              Nonemergency transport bus  00      9                                                                                                     I                          O1A D      01984010119950101        N                           
A0120001003Non-emergency transportation: mini-bus, mountain area transports, or other      Noner transport mini-bus    00      9                                                                                                     I                          O1A D      01982010120030101        N                           
A0120002004transportation systems                                                                                                                                                                                                                                                                                               
A0130001003Non-emergency transportation: wheelchair van                                    Noner transport wheelch van 00      9                                                                                                     I                          O1A D      01982010119820101        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      01982010119820101        N                           
A0190001003Non-emergency transportation: ancillary: meals-recipient                        Noner transport meals recip 00      9                                                                                                     I                          O1A D      01984010119840101        N                           
A0200001003Non-emergency transportation: ancillary: lodging escort                         Noner transport lodgng escrt00      9                                                                                                     I                          O1A D      01982010119820101        N                           
A0210001003Non-emergency transportation: ancillary: meals-escort                           Noner transport meals escort00      9                                                                                                     I                          O1A D      01984010119840101        N                           
A0225001003Ambulance service, neonatal transport, base rate, emergency transport, one way  Neonatal emergency transport00      9                                                                                                     I                          O1A D      01985010120030401        N                           
A0380001003Bls mileage (per mile)                                                          Basic life support mileage  00      9                                                                            A0425                    I                          O1A D      01995010120030101        N                           
A0382001003Bls routine disposable supplies                                                 Basic support routine suppls00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0384001003Bls specialized service disposable supplies; defibrillation (used by als        Bls defibrillation supplies 00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0384002004ambulances and bls ambulances in jurisdictions where defibrillation is                                                                                                                                                                                                                                               
A0384003004permitted in bls ambulances)                                                                                                                                                                                                                                                                                         
A0390001003Als mileage (per mile)                                                          Advanced life support mileag00      9                                                                            A0425                    I                          O1A D      01995010120030101        N                           
A0392001003Als specialized service disposable supplies; defibrillation (to be used only in Als defibrillation supplies 00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0392002004jurisdictions where defibrillation cannot be performed in bls ambulances)                                                                                                                                                                                                                                            
A0394001003Als specialized service disposable supplies; iv drug therapy                    Als iv drug therapy supplies00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0396001003Als specialized service disposable supplies; esophageal intubation              Als esophageal intub suppls 00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0398001003Als routine disposable supplies                                                 Als routine disposble suppls00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0420001003Ambulance waiting time (als or bls), one half (1/2) hour increments             Ambulance waiting 1/2 hr    00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0422001003Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation    Ambulance 02 life sustaining00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0424001003Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); Extra ambulance attendant   00      9                                                                                                     I                          O1A D      01995010120140101        N                           
A0424002004(requires medical review)                                                                                                                                                                                                                                                                                            
A0425001003Ground mileage, per statute mile                                                Ground mileage              52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0426001003Ambulance service, advanced life support, non-emergency transport, level 1 (als Als 1                       52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A04260020041)                                                                                                                                                                                                                                                                                                                   
A0427001003Ambulance service, advanced life support, emergency transport, level 1 (als 1 - Als1-emergency              52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0427002004emergency)                                                                                                                                                                                                                                                                                                           
A0428001003Ambulance service, basic life support, non-emergency transport, (bls)           Bls                         52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0429001003Ambulance service, basic life support, emergency transport (bls-emergency)      Bls-emergency               52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0430001003Ambulance service, conventional air services, transport, one way (fixed wing)   Fixed wing air transport    52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0431001003Ambulance service, conventional air services, transport, one way (rotary wing)  Rotary wing air transport   52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0432001003Paramedic intercept (pi), rural area, transport furnished by a volunteer        Pi volunteer ambulance co   52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0432002004ambulance company which is prohibited by state law from billing third party                                                                                                                                                                                                                                          
A0432003004payers                                                                                                                                                                                                                                                                                                               
A0433001003Advanced life support, level 2 (als 2)                                          Als 2                       52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0434001003Specialty care transport (sct)                                                  Specialty care transport    52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0435001003Fixed wing air mileage, per statute mile                                        Fixed wing air mileage      52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0436001003Rotary wing air mileage, per statute mile                                       Rotary wing air mileage     52      A                                                                                                     C                          O1A D      02001010120010101        N                           
A0888001003Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest Noncovered ambulance mileage00      9                  2125                                                                               M                          O1A D      01995010119950101        N                           
A0888002004appropriate facility)                                                                                                                                                                                                                                                                                                
A0998001003Ambulance response and treatment, no transport                                  Ambulance response/treatment00      9                                                                                                     I                          O1A D      02006010120060101        N                           
A0999001003Unlisted ambulance service                                                      Unlisted ambulance service  57      A                  2120.1  2125                                                                       D                          O1A D      01987010119980101        N                           
A4206001003Syringe with needle, sterile, 1 cc or less, each                                1 cc sterile syringe&needle 00      9                                                                                                     C                          D1A S      01985010120080101        N                           
A4207001003Syringe with needle, sterile 2 cc, each                                         2 cc sterile syringe&needle 00      9                                                                                                     C                          D1A S      01985010120070101        N                           
A4208001003Syringe with needle, sterile 3 cc, each                                         3 cc sterile syringe&needle 00      9                                                                                                     C                          D1A S      01985010120070101        N                           
A4209001003Syringe with needle, sterile 5 cc or greater, each                              5+ cc sterile syringe&needle00      9                                                                                                     C                          D1A S      01985010120070101        N                           
A4210001003Needle-free injection device, each                                              Nonneedle injection device  00      960-9                                                                                                 M                          D1A S      01989010119960101        N                           
A4211001003Supplies for self-administered injections                                       Supp for self-adm injections00      9                  2049                                                                               D                          D1A S      01993010119970101        N                           
A4212001003Non-coring needle or stylet with or without catheter                            Non coring needle or stylet 57      A                                                                                                     C                          D1A S      01993010120000101        N                           
A4213001003Syringe, sterile, 20 cc or greater, each                                        20+ cc syringe only         00      9                                                                                                     C                          D1A S      01985010120070101        N                           
A4215001003Needle, sterile, any size, each                                                 Sterile needle              00      9                                                                                                     C                          D1A LS     01985010120070101        N                           
A4216001003Sterile water, saline and/or dextrose, diluent/flush, 10 ml                     Sterile water/saline, 10 ml 37      A                  2049                                                                               D                          D1F 1LP    02004010120070101        N                           
A4217001003Sterile water/saline, 500 ml                                                    Sterile water/saline, 500 ml37      A                  2049                                                                               D                          D1F 1LP    02004010120040101        N                           
A4218001003Sterile saline or water, metered dose dispenser, 10 ml                          Sterile saline or water     51      A                                                                                                     D                      0127O1E 1LP    02006010120060101        N                           
A4220001003Refill kit for implantable infusion pump                                        Infusion pump refill kit    57      A60-14                                                                                                D                      0050D1A P      01994010119980303        N                           
A4221001003Supplies for maintenance of non-insulin drug infusion catheter, per week (list  Supp non-insulin inf cath/wk34      A                                                                                                     C                          D1E P      01997010120170101        N                           
A4221002004drugs  separately)                                                                                                                                                                                                                                                                                                   
A4222001003Infusion supplies for external drug infusion pump, per cassette or bag (list    Infusion supplies with pump 34      A                                                                                                     C                          D1E P      01997010120050101        N                           
A4222002004drugs separately)                                                                                                                                                                                                                                                                                                    
A4223001003Infusion supplies not used with external infusion pump, per cassette or bag     Infusion supplies w/o pump  00      9                                                                                                     C                          D1A P      02005010120070101        N                           
A4223002004(list drugs separately)                                                                                                                                                                                                                                                                                              
A4224001003Supplies for maintenance of insulin infusion catheter, per week                 Supply insulin inf cath/wk  34      A                                                                                                     C                          D1E P      02017010120170101        N                           
A4225001003Supplies for external insulin infusion pump, syringe type cartridge, sterile,   Sup/ext insulin inf pump syr34      A                  60-14                                                                              D                          D1E P      02017010120170101        N                           
A4225002004each                                                                                                                                                                                                                                                                                                                 
A4230001003Infusion set for external insulin pump, non needle cannula type                 Infus insulin pump non needl34      A60-14                                                                                                D                          D1E P      01996010120000101        N                           
A4231001003Infusion set for external insulin pump, needle type                             Infusion insulin pump needle34      A60-14                                                                                                D                          D1E P      01996010120000101        N                           
A4232001003Syringe with needle for external insulin pump, sterile, 3 cc                    Syringe w/needle insulin 3cc00      960-14                                                                                                I                          D1E P      01996010120030401        N                           
A4233001003Replacement battery, alkaline (other than j cell), for use with medically       Alkalin batt for glucose mon32      A                                                                                                     C                          D1E P      02006010120160101        N                           
A4233002004necessary home blood glucose monitor owned by patient, each                                                                                                                                                                                                                                                          
A4234001003Replacement battery, alkaline, j cell, for use with medically necessary home    J-cell batt for glucose mon 32      A                                                                                                     C                          D1E P      02006010120160101        N                           
A4234002004blood glucose monitor owned by patient, each                                                                                                                                                                                                                                                                         
A4235001003Replacement battery, lithium, for use with medically necessary home blood       Lithium batt for glucose mon32      A                                                                                                     C                          D1E P      02006010120160101        N                           
A4235002004glucose monitor owned by patient, each                                                                                                                                                                                                                                                                               
A4236001003Replacement battery, silver oxide, for use with medically necessary home blood  Silvr oxide batt glucose mon32      A                                                                                                     C                          D1E P      02006010120160101        N                           
A4236002004glucose monitor owned by patient, each                                                                                                                                                                                                                                                                               
A4244001003Alcohol or peroxide, per pint                                                   Alcohol or peroxide per pint00      9                                                                                                     C                          D1A LS     01985010120070101        N                           
A4245001003Alcohol wipes, per box                                                          Alcohol wipes per box       00      9                                                                                                     C                          D1A LS     01985010120070101        N                           
A4246001003Betadine or phisohex solution, per pint                                         Betadine/phisohex solution  00      9                                                                                                     C                          D1A LS     01985010120070101        N                           
A4247001003Betadine or iodine swabs/wipes, per box                                         Betadine/iodine swabs/wipes 00      9                                                                                                     C                          D1A LS     01985010120070101        N                           
A4248001003Chlorhexidine containing antiseptic, 1 ml                                       Chlorhexidine antisept      00      9                                                                                                     C                          P9B L      02004010120150101        N                           
A4250001003Urine test or reagent strips or tablets (100 tablets or strips)                 Urine reagent strips/tablets00      9                  2100                                                                               M                          T1E 9      01990010119970101        N                           
A4252001003Blood ketone test or reagent strip, each                                        Blood ketone test or strip  00      9                                          1861(n)                                                    S                          D1E P      02008010120080101        N                           
A4253001003Blood glucose test or reagent strips for home blood glucose monitor, per 50     Blood glucose/reagent strips32      A60-11                                                                                                D                          D1E P      01986010119980701        N                           
A4253002004strips                                                                                                                                                                                                                                                                                                               
A4255001003Platforms for home blood glucose monitor, 50 per box                            Glucose monitor platforms   34      A60-11                                                                                                D                          D1E P      01997010120020101        N                           
A4256001003Normal, low and high calibrator solution / chips                                Calibrator solution/chips   34      A60-11                                                                                                D                          D1E P      01985010120020101        N                           
A4257001003Replacement lens shield cartridge for use with laser skin piercing device, each Replace lensshield cartridge34      A                                                                                                     C                          D1E P      02002010120020101        N                           
A4258001003Spring-powered device for lancet, each                                          Lancet device each          34      A60-11                                                                                                D                          D1E P      01996010120020101        N                           
A4259001003Lancets, per box of 100                                                         Lancets per box             34      A60-11                                                                                                D                          D1E P      01985010119960101        N                           
A4261001003Cervical cap for contraceptive use                                              Cervical cap contraceptive  00      9                                          1862a1                                                     S                          Z2  9      01999010119990101        N                           
A4262001003Temporary, absorbable lacrimal duct implant, each                               Temporary tear duct plug    00      9                                                                                                     D                      0052D1A 9      01994010119980101        N                           
A4263001003Permanent, long term, non-dissolvable lacrimal duct implant, each               Permanent tear duct plug    11      A                  15030                                                                              D                          Y1  9      01994010119980101        N                           
A4264001003Permanent implantable contraceptive intratubal occlusion device(s) and delivery Intratubal occlusion device 00      9                                                                                                     I                          Z2  9      02010010120100101        N                           
A4264002004system                                                                                                                                                                                                                                                                                                               
A4265001003Paraffin, per pound                                                             Paraffin                    34      A60-9                                                                                                 D                          D1E 9      01986010120020101        N                           
A4266001003Diaphragm for contraceptive use                                                 Diaphragm                   00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4267001003Contraceptive supply, condom, male, each                                        Male condom                 00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4268001003Contraceptive supply, condom, female, each                                      Female condom               00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4269001003Contraceptive supply, spermicide (e.g., foam, gel), each                        Spermicide                  00      9                                                                                                     I                          Z2  9      02003010120030101        N                           
A4270001003Disposable endoscope sheath, each                                               Disposable endoscope sheath 00      9                                                                                                     C                          P8D 9      01994010119960101        N                           
A4280001003Adhesive skin support attachment for use with external breast prosthesis, each  Brst prsths adhsv attchmnt  38      A                                                                                                     C                          D1F P      02000010120000101        N                           
A4281001003Tubing for breast pump, replacement                                             Replacement breastpump tube 00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4282001003Adapter for breast pump, replacement                                            Replacement breastpump adpt 00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4283001003Cap for breast pump bottle, replacement                                         Replacement breastpump cap  00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4284001003Breast shield and splash protector for use with breast pump, replacement        Replcmnt breast pump shield 00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4285001003Polycarbonate bottle for use with breast pump, replacement                      Replcmnt breast pump bottle 00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4286001003Locking ring for breast pump, replacement                                       Replcmnt breastpump lok ring00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4290001003Sacral nerve stimulation test lead, each                                        Sacral nerve stim test lead 00      9                                                                                                     C                          Z2  9      02001010120020101        N                           
A4300001003Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or Cath impl vasc access portal11      A                  2130                                                                               D                          Y1  S      01986010120020101        N                           
A4300002004peritoneal, etc.) external access                                                                                                                                                                                                                                                                                    
A4301001003Implantable access total catheter, port/reservoir (e.g., venous, arterial,      Implantable access syst perc00      9                                                                                                     C                          D1A S      01996010120030101        N                           
A4301002004epidural, subarachnoid, peritoneal, etc.)                                                                                                                                                                                                                                                                            
A4305001003Disposable drug delivery system, flow rate of 50 ml or greater per hour         Drug delivery system >=50 ml00      9                                                                                                     C                          D1A 9      01993010120060101        N                           
A4306001003Disposable drug delivery system, flow rate of less than 50 ml per hour          Drug delivery system <=50 ml00      9                                                                                                     C                          D1A 9      01993010120070101        N                           
A4310001003Insertion tray without drainage bag and without catheter (accessories only)     Insert tray w/o bag/cath    37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4311001003Insertion tray without drainage bag with indwelling catheter, foley type,       Catheter w/o bag 2-way latex37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4311002004two-way latex with coating (teflon, silicone, silicone elastomer or                                                                                                                                                                                                                                                  
A4311003004hydrophilic, etc.)                                                                                                                                                                                                                                                                                                   
A4312001003Insertion tray without drainage bag with indwelling catheter, foley type,       Cath w/o bag 2-way silicone 37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4312002004two-way, all silicone                                                                                                                                                                                                                                                                                                
A4313001003Insertion tray without drainage bag with indwelling catheter, foley type,       Catheter w/bag 3-way        37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4313002004three-way, for continuous irrigation                                                                                                                                                                                                                                                                                 
A4314001003Insertion tray with drainage bag with indwelling catheter, foley type, two-way  Cath w/drainage 2-way latex 37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4314002004latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)                                                                                                                                                                                                                                       
A4315001003Insertion tray with drainage bag with indwelling catheter, foley type, two-way, Cath w/drainage 2-way silcne37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4315002004all silicone                                                                                                                                                                                                                                                                                                         
A4316001003Insertion tray with drainage bag with indwelling catheter, foley type,          Cath w/drainage 3-way       37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4316002004three-way, for continuous irrigation                                                                                                                                                                                                                                                                                 
A4320001003Irrigation tray with bulb or piston syringe, any purpose                        Irrigation tray             37      A                  2130                                                                               D                          D1A P      01990010119920101        N                           
A4321001003Therapeutic agent for urinary catheter irrigation                               Cath therapeutic irrig agent37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4322001003Irrigation syringe, bulb or piston, each                                        Irrigation syringe          37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4326001003Male external catheter with integral collection chamber, any type, each         Male external catheter      37      A                  2130                                                                               D                          D1F P      01990010120070101        N                           
A4327001003Female external urinary collection device; meatal cup, each                     Fem urinary collect dev cup 37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4328001003Female external urinary collection device; pouch, each                          Fem urinary collect pouch   37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4330001003Perianal fecal collection pouch with adhesive, each                             Stool collection pouch      37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4331001003Extension drainage tubing, any type, any length, with connector/adaptor, for    Extension drainage tubing   37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4331002004use with urinary leg bag or urostomy pouch, each                                                                                                                                                                                                                                                                     
A4332001003Lubricant, individual sterile packet, each                                      Lube sterile packet         37      A                  2130                                                                               D                          D1F P      02001010120050101        N                           
A4333001003Urinary catheter anchoring device, adhesive skin attachment, each               Urinary cath anchor device  37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4334001003Urinary catheter anchoring device, leg strap, each                              Urinary cath leg strap      37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4335001003Incontinence supply; miscellaneous                                              Incontinence supply         46      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A4336001003Incontinence supply, urethral insert, any type, each                            Urethral insert             37      A                                                                                                     D                      0124D1F P      02010010120100101        N                           
A4337001003Incontinence supply, rectal insert, any type, each                              Incontinent rectal insert   38      A                  2130                                                                               D                          D1F P      02016010120160101        N                           
A4338001003Indwelling catheter; foley type, two-way latex with coating (teflon, silicone,  Indwelling catheter latex   37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4338002004silicone elastomer, or hydrophilic, etc.), each                                                                                                                                                                                                                                                                      
A4340001003Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each  Indwelling catheter special 37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4344001003Indwelling catheter, foley type, two-way, all silicone, each                    Cath indw foley 2 way silicn37      A                  2130                                                                               D                          D1F P      01983010119960101        N                           
A4346001003Indwelling catheter; foley type, three way for continuous irrigation, each      Cath indw foley 3 way       37      A                  2130                                                                               D                          D1F P      01983010119960101        N                           
A4349001003Male external catheter, with or without adhesive, disposable, each              Disposable male external cat37      A                  2130                                                                               D                          D1A P      02005010120050101        N                           
A4351001003Intermittent urinary catheter; straight tip, with or without coating (teflon,   Straight tip urine catheter 37      A                  2130                                                                               D                          D1F P      01990010120020101        N                           
A4351002004silicone, silicone elastomer, or hydrophilic, etc.), each                                                                                                                                                                                                                                                            
A4352001003Intermittent urinary catheter; coude (curved) tip, with or without coating      Coude tip urinary catheter  37      A                  2130                                                                               D                          D1F P      01990010120020101        N                           
A4352002004(teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each                                                                                                                                                                                                                                                 
A4353001003Intermittent urinary catheter, with insertion supplies                          Intermittent urinary cath   37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4354001003Insertion tray with drainage bag but without catheter                           Cath insertion tray w/bag   37      A                  2130                                                                               D                          D1F P      01986010119900101        N                           
A4355001003Irrigation tubing set for continuous bladder irrigation through a three-way     Bladder irrigation tubing   37      A                  2130                                                                               D                          D1F P      01984010119960101        N                           
A4355002004indwelling foley catheter, each                                                                                                                                                                                                                                                                                      
A4356001003External urethral clamp or compression device (not to be used for catheter      Ext ureth clmp or compr dvc 37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4356002004clamp), each                                                                                                                                                                                                                                                                                                         
A4357001003Bedside drainage bag, day or night, with or without anti-reflux device, with or Bedside drainage bag        37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4357002004without tube, each                                                                                                                                                                                                                                                                                                   
A4358001003Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, Urinary leg or abdomen bag  37      A                  2130                                                                               D                          D1F P      01985010120020101        N                           
A4358002004each                                                                                                                                                                                                                                                                                                                 
A4360001003Disposable external urethral clamp or compression device, with pad and/or       Disposable ext urethral dev 37      A                                                                                                     D                      0124D1F 9      02010010120100101        N                           
A4360002004pouch, each                                                                                                                                                                                                                                                                                                          
A4361001003Ostomy faceplate, each                                                          Ostomy face plate           37      A                  2130                                                                               D                          D1F P      01985010119960101        N                           
A4362001003Skin barrier; solid, 4 x 4 or equivalent; each                                  Solid skin barrier          37      A                  2130                                                                               D                          D1F P      01985010119900101        N                           
A4363001003Ostomy clamp, any type, replacement only, each                                  Ostomy clamp, replacement   37      A                                                                                                     D                      0124D1F P      02006010120060101        N                           
A4364001003Adhesive, liquid or equal, any type, per oz                                     Adhesive, liquid or equal   37      A                  2130                                                                               D                          D1F P      01985010120030101        N                           
A4366001003Ostomy vent, any type, each                                                     Ostomy vent                 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4367001003Ostomy belt, each                                                               Ostomy belt                 37      A                  2130A                                                                              D                          D1F P      01985010119960101        N                           
A4368001003Ostomy filter, any type, each                                                   Ostomy filter               37      A                                                                                                     C                          D1F P      01997010119970101        N                           
A4369001003Ostomy skin barrier, liquid (spray, brush, etc.), per oz                        Skin barrier liquid per oz  37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4371001003Ostomy skin barrier, powder, per oz                                             Skin barrier powder per oz  37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4372001003Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in    Skin barrier solid 4x4 equiv37      A                  2130                                                                               D                          D1F P      02000010120060101        N                           
A4372002004convexity, each                                                                                                                                                                                                                                                                                                      
A4373001003Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in  Skin barrier with flange    37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4373002004convexity, any size, each                                                                                                                                                                                                                                                                                            
A4375001003Ostomy pouch, drainable, with faceplate attached, plastic, each                 Drainable plastic pch w fcpl37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4376001003Ostomy pouch, drainable, with faceplate attached, rubber, each                  Drainable rubber pch w fcplt37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4377001003Ostomy pouch, drainable, for use on faceplate, plastic, each                    Drainable plstic pch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4378001003Ostomy pouch, drainable, for use on faceplate, rubber, each                     Drainable rubber pch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4379001003Ostomy pouch, urinary, with faceplate attached, plastic, each                   Urinary plastic pouch w fcpl37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4380001003Ostomy pouch, urinary, with faceplate attached, rubber, each                    Urinary rubber pouch w fcplt37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4381001003Ostomy pouch, urinary, for use on faceplate, plastic, each                      Urinary plastic pouch w/o fp37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4382001003Ostomy pouch, urinary, for use on faceplate, heavy plastic, each                Urinary hvy plstc pch w/o fp37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4383001003Ostomy pouch, urinary, for use on faceplate, rubber, each                       Urinary rubber pouch w/o fp 37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4384001003Ostomy faceplate equivalent, silicone ring, each                                Ostomy faceplt/silicone ring37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4385001003Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in Ost skn barrier sld ext wear37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4385002004convexity, each                                                                                                                                                                                                                                                                                                      
A4387001003Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), Ost clsd pouch w att st barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4387002004each                                                                                                                                                                                                                                                                                                                 
A4388001003Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each   Drainable pch w ex wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4389001003Ostomy pouch, drainable, with barrier attached, with built-in convexity (1      Drainable pch w st wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4389002004piece), each                                                                                                                                                                                                                                                                                                         
A4390001003Ostomy pouch, drainable, with extended wear barrier attached, with built-in     Drainable pch ex wear convex37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4390002004convexity (1 piece), each                                                                                                                                                                                                                                                                                            
A4391001003Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each      Urinary pouch w ex wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4392001003Ostomy pouch, urinary, with standard wear barrier attached, with built-in       Urinary pouch w st wear barr37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4392002004convexity (1 piece), each                                                                                                                                                                                                                                                                                            
A4393001003Ostomy pouch, urinary, with extended wear barrier attached, with built-in       Urine pch w ex wear bar conv37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4393002004convexity (1 piece), each                                                                                                                                                                                                                                                                                            
A4394001003Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid Ostomy pouch liq deodorant  37      A                  2130                                                                               D                          D1F P      02000010120070101        N                           
A4394002004ounce                                                                                                                                                                                                                                                                                                                
A4395001003Ostomy deodorant for use in ostomy pouch, solid, per tablet                     Ostomy pouch solid deodorant37      A                  2130                                                                               D                          D1F P      02000010120030101        N                           
A4396001003Ostomy belt with peristomal hernia support                                      Peristomal hernia supprt blt37      A                  2130                                                                               D                          D1F P      02001010120030101        N                           
A4397001003Irrigation supply; sleeve, each                                                 Irrigation supply sleeve    37      A                  2130                                                                               D                          D1F P      01990010119960101        N                           
A4398001003Ostomy irrigation supply; bag, each                                             Ostomy irrigation bag       37      A                  2130                                                                               D                          D1F P      01989010119970101        N                           
A4399001003Ostomy irrigation supply; cone/catheter, with or without brush                  Ostomy irrig cone/cath w brs37      A                  2130                                                                               D                          D1F P      01989010120110101        N                           
A4400001003Ostomy irrigation set                                                           Ostomy irrigation set       37      A                  2130                                                                               D                          D1F P      01982010119900101        N                           
A4402001003Lubricant, per ounce                                                            Lubricant per ounce         37      A                  2130                                                                               D                          D1F P      01985010119950101        N                           
A4404001003Ostomy ring, each                                                               Ostomy ring each            37      A                  2130                                                                               D                          D1F P      01985010119950101        N                           
A4405001003Ostomy skin barrier, non-pectin based, paste, per ounce                         Nonpectin based ostomy paste37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4406001003Ostomy skin barrier, pectin-based, paste, per ounce                             Pectin based ostomy paste   37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4407001003Ostomy skin barrier, with flange (solid, flexible, or accordion), extended      Ext wear ost skn barr <=4sq"37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4407002004wear, with built-in convexity, 4 x 4 inches or smaller, each                                                                                                                                                                                                                                                         
A4408001003Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, Ext wear ost skn barr >4sq" 37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4408002004with built-in convexity, larger than 4 x 4 inches, each                                                                                                                                                                                                                                                              
A4409001003Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, Ost skn barr convex <=4 sq i37      A                  2130                                                                               D                          D1F P      02003010120060101        N                           
A4409002004without built-in convexity, 4 x 4 inches or smaller, each                                                                                                                                                                                                                                                            
A4410001003Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, Ost skn barr extnd >4 sq    37      A                  2130                                                                               D                          D1F P      02003010120060101        N                           
A4410002004without built-in convexity, larger than 4 x 4 inches, each                                                                                                                                                                                                                                                           
A4411001003Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in    Ost skn barr extnd =4sq     37      A                                                                                                     D                      0124D1F P      02006010120060101        N                           
A4411002004convexity, each                                                                                                                                                                                                                                                                                                      
A4412001003Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece Ost pouch drain high output 37      A                  2130                                                                               D                      0124D1F P      02006010120060101        N                           
A4412002004system), without filter, each                                                                                                                                                                                                                                                                                        
A4413001003Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece 2 pc drainable ost pouch    37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4413002004system), with filter, each                                                                                                                                                                                                                                                                                           
A4414001003Ostomy skin barrier, with flange (solid, flexible or accordion), without        Ost sknbar w/o conv<=4 sq in37      A                  2130                                                                               D                          D1F P      02003010120060101        N                           
A4414002004built-in convexity, 4 x 4 inches or smaller, each                                                                                                                                                                                                                                                                    
A4415001003Ostomy skin barrier, with flange (solid, flexible or accordion), without        Ost skn barr w/o conv >4 sqi37      A                  2130                                                                               D                          D1F P      02003010120060101        N                           
A4415002004built-in convexity, larger than 4 x 4 inches, each                                                                                                                                                                                                                                                                   
A4416001003Ostomy pouch, closed, with barrier attached, with filter (1 piece), each        Ost pch clsd w barrier/filtr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4417001003Ostomy pouch, closed, with barrier attached, with built-in convexity, with      Ost pch w bar/bltinconv/fltr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4417002004filter (1 piece), each                                                                                                                                                                                                                                                                                               
A4418001003Ostomy pouch, closed; without barrier attached, with filter (1 piece), each     Ost pch clsd w/o bar w filtr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4419001003Ostomy pouch, closed; for use on barrier with non-locking flange, with filter   Ost pch for bar w flange/flt37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4419002004(2 piece), each                                                                                                                                                                                                                                                                                                      
A4420001003Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each    Ost pch clsd for bar w lk fl37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4421001003Ostomy supply; miscellaneous                                                    Ostomy supply misc          46      A                                                                                                     C                          D1F P      01985010120180101        N                           
A4422001003Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to Ost pouch absorbent material37      A                  2130                                                                               D                          D1F P      02003010120030101        N                           
A4422002004thicken liquid stomal output, each                                                                                                                                                                                                                                                                                   
A4423001003Ostomy pouch, closed; for use on barrier with locking flange, with filter (2    Ost pch for bar w lk fl/fltr37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4423002004piece), each                                                                                                                                                                                                                                                                                                         
A4424001003Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each     Ost pch drain w bar & filter37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4425001003Ostomy pouch, drainable; for use on barrier with non-locking flange, with       Ost pch drain for barrier fl37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4425002004filter (2 piece system), each                                                                                                                                                                                                                                                                                        
A4426001003Ostomy pouch, drainable; for use on barrier with locking flange (2 piece        Ost pch drain 2 piece system37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4426002004system), each                                                                                                                                                                                                                                                                                                        
A4427001003Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 Ost pch drain/barr lk flng/f37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4427002004piece system), each                                                                                                                                                                                                                                                                                                  
A4428001003Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type    Urine ost pouch w faucet/tap37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4428002004tap with valve (1 piece), each                                                                                                                                                                                                                                                                                       
A4429001003Ostomy pouch, urinary, with barrier attached, with built-in convexity, with     Urine ost pouch w bltinconv 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4429002004faucet-type tap with valve (1 piece), each                                                                                                                                                                                                                                                                           
A4430001003Ostomy pouch, urinary, with extended wear barrier attached, with built-in       Ost urine pch w b/bltin conv37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4430002004convexity, with faucet-type tap with valve (1 piece), each                                                                                                                                                                                                                                                           
A4431001003Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve   Ost pch urine w barrier/tapv37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4431002004(1 piece), each                                                                                                                                                                                                                                                                                                      
A4432001003Ostomy pouch, urinary; for use on barrier with non-locking flange, with         Os pch urine w bar/fange/tap37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4432002004faucet-type tap with valve (2 piece), each                                                                                                                                                                                                                                                                           
A4433001003Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each   Urine ost pch bar w lock fln37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4434001003Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type Ost pch urine w lock flng/ft37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A4434002004tap with valve (2 piece), each                                                                                                                                                                                                                                                                                       
A4435001003Ostomy pouch, drainable, high output, with extended wear barrier (one-piece     1pc ost pch drain hgh output37      A                                                                                                     C                          D1F P      02013010120130101        N                           
A4435002004system), with or without filter, each                                                                                                                                                                                                                                                                                
A4450001003Tape, non-waterproof, per 18 square inches                                      Non-waterproof tape         37      A                  2130                                                                               D                          D1F LP     02003010120030101        N                           
A4452001003Tape, waterproof, per 18 square inches                                          Waterproof tape             37      A                  2130                                                                               D                          D1F LP     02003010120030101        N                           
A4455001003Adhesive remover or solvent (for tape, cement or other adhesive), per ounce     Adhesive remover per ounce  37      A                  2130                                                                               D                          D1F P      01989010119950101        N                           
A4456001003Adhesive remover, wipes, any type, each                                         Adhesive remover, wipes     37      A                  2130                                                                               D                          D1F P      02010010120100101        N                           
A4458001003Enema bag with tubing, reusable                                                 Reusable enema bag          00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A4459001003Manual pump-operated enema system, includes balloon, catheter and all           Manual pump enema, reusable 00      9                                                                                                     C                          Z2  9      02015010120150101        N                           
A4459002004accessories, reusable, any type                                                                                                                                                                                                                                                                                      
A4461001003Surgical dressing holder, non-reusable, each                                    Surgicl dress hold non-reuse35      A                                                                                                     C                          D1A S      02007010120070101        N                           
A4463001003Surgical dressing holder, reusable, each                                        Surgical dress holder reuse 35      A                                                                                                     C                          D1A S      02007010120070101        N                           
A4465001003Non-elastic binder for extremity                                                Non-elastic extremity binder00      9                                                                                                     C                          D1A 9      01994010119950101        N                           
A4466001003Garment, belt, sleeve or other covering, elastic or similar stretchable         Elastic garment/covering    00      9                                                                            A4467                    M                      0196Z2  9      0201001012017010120161231N                           
A4466002004material, any type, each                                                                                                                                                                                                                                                                                             
A4467001003Belt, strap, sleeve, garment, or covering, any type                             Belt strap sleev grmnt cover00      9                                                                                                     M                      0208Z2  9      02017010120170101        N                           
A4470001003Gravlee jet washer                                                              Gravlee jet washer          00      950-4              2320                                                                               D                          D1A P      01986010120010101        N                           
A4480001003Vabra aspirator                                                                 Vabra aspirator             00      950-10             2320                                                                               D                          D1A P      01986010120010101        N                           
A4481001003Tracheostoma filter, any type, any size, each                                   Tracheostoma filter         37      A                  2130                                                                               D                          D1F P      01997010120030101        N                           
A4483001003Moisture exchanger, disposable, for use with invasive mechanical ventilation    Moisture exchanger          37      A                  2130                                                                               D                          D1F P      01999010120030101        N                           
A4490001003Surgical stockings above knee length, each                                      Above knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4495001003Surgical stockings thigh length, each                                           Thigh length surg stocking  00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4500001003Surgical stockings below knee length, each                                      Below knee surgical stocking00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4510001003Surgical stockings full length, each                                            Full length surg stocking   00      960-9              2079    2100                                                                       M                          D1A P      01986010120030101        N                           
A4520001003Incontinence garment, any type, (e.g., brief, diaper), each                     Incontinence garment anytype00      960-9                                                                                                 M                          D1A 9      02005010120050101        N                           
A4550001003Surgical trays                                                                  Surgical trays              11      A                  15030                                                                              D                          Y1  9      01982010120000101        N                           
A4553001003Non-disposable underpads, all sizes                                             Nondisp underpads, all sizes00      960-9                                                                                                 M                          D1A 9      02017010120170101        N                           
A4554001003Disposable underpads, all sizes                                                 Disposable underpads        00      960-9                                                                                                 M                          D1A 9      01986010120050101        N                           
A4555001003Electrode/transducer for use with electrical stimulation device used for cancer Ca tx e-stim electr/transduc00      9                                                                                                     I                          D1E P      02014010120140101        N                           
A4555002004treatment, replacement only                                                                                                                                                                                                                                                                                          
A4556001003Electrodes, (e.g., apnea monitor), per pair                                     Electrodes, pair            34      A                                                                                                     C                          D1E P      01984010120000101        N                           
A4557001003Lead wires, (e.g., apnea monitor), per pair                                     Lead wires, pair            34      A                                                                                                     C                          D1E P      01984010120000101        N                           
A4558001003Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per Conductive gel or paste     34      A                                                                                                     C                          D1E P      01985010120070101        N                           
A4558002004oz                                                                                                                                                                                                                                                                                                                   
A4559001003Coupling gel or paste, for use with ultrasound device, per oz                   Coupling gel or paste       34      A                                                                                                     C                          D1E P      02007010120070101        N                           
A4561001003Pessary, rubber, any type                                                       Pessary rubber, any type    38      A                                                                                                     C                          D1F P      02001010120010101        N                           
A4562001003Pessary, non rubber, any type                                                   Pessary, non rubber,any type38      A                                                                                                     C                          D1F P      02001010120010101        N                           
A4563001003Rectal control system for vaginal insertion, for long term use, includes pump   Vag inser rectal control sys38      A                                                                                                     C                          D1F P      02019010120190101        A                           
A4563002004and all supplies and accessories, any type each                                                                                                                                                                                                                                                                      
A4565001003Slings                                                                          Slings                      55      A                                                                                                     C                          D1A P      01983010120141001        N                           
A4566001003Shoulder sling or vest design, abduction restrainer, with or without swathe     Should sling/vest/abrestrain00      9                                                                                                     I                          Z2  9      02011010120110101        N                           
A4566002004control, prefabricated, includes fitting and adjustment                                                                                                                                                                                                                                                              
A4570001003Splint                                                                          Splint                      52      A                  2079                                                                               I                          D1A P      01982010120010701        N                           
A4575001003Topical hyperbaric oxygen chamber, disposable                                   Hyperbaric o2 chamber disps 00      9                                                                                                     C                      0170D1A 9      01996010120171001        N                           
A4580001003Cast supplies (e.g., plaster)                                                   Cast supplies (plaster)     00      9                  2079                                                                               I                          D1A 9      01982010119820101        N                           
A4590001003Special casting material (e.g., fiberglass)                                     Special casting material    00      9                  2079                                                                               I                          D1A 9      01984010119840101        N                           
A4595001003Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)           Tens suppl 2 lead per month 34      A45-25                                                                                                D                          D1E P      01996010120030101        N                           
A4600001003Sleeve for intermittent limb compression device, replacement only, each         Sleeve, inter limb comp dev 32      A                                                                                                     C                          D1E P      02007010120070101        N                           
A4601001003Lithium ion battery, rechargeable, for non-prosthetic use, replacement          Lith ion non prosth recharge32      A                                                                                                     C                          D1E P      02007010120150101        N                           
A4602001003Replacement battery for external infusion pump owned by patient, lithium, 1.5   Replace lithium battery 1.5v32      A                                                                                                     C                          D1E P      02015010120150101        N                           
A4602002004volt, each                                                                                                                                                                                                                                                                                                           
A4604001003Tubing with integrated heating element for use with positive airway pressure    Tubing with heating element 32      A                                                                                                     C                          D1E P      02006010120060101        N                           
A4604002004device                                                                                                                                                                                                                                                                                                               
A4605001003Tracheal suction catheter, closed system, each                                  Trach suction cath close sys32      A                                                                                                     C                          D1E P      02005010120050101        N                           
A4606001003Oxygen probe for use with oximeter device, replacement                          Oxygen probe used w oximeter00      9                                                                                                     C                          D1E 9      02003010120030101        N                           
A4608001003Transtracheal oxygen catheter, each                                             Transtracheal oxygen cath   00      9                                                                                                     C                          D1C P      02001010120140101        N                           
A4611001003Battery, heavy duty; replacement for patient owned ventilator                   Heavy duty battery          00      9                                          1834a3A                                                    S                          D1E P      01990010120140101        N                           
A4612001003Battery cables; replacement for patient-owned ventilator                        Battery cables              00      9                                          1834a3A                                                    S                          D1E P      01990010120140101        N                           
A4613001003Battery charger; replacement for patient-owned ventilator                       Battery charger             00      9                                          1834a3A                                                    S                          D1E P      01990010120140101        N                           
A4614001003Peak expiratory flow rate meter, hand held                                      Hand-held pefr meter        46      A                                                                                                     C                          Z2  9      01999010119990101        N                           
A4615001003Cannula, nasal                                                                  Cannula nasal               00      960-4              3312                                                                               D                          D1C P      01990010120090101        N                           
A4616001003Tubing (oxygen), per foot                                                       Tubing (oxygen) per foot    00      960-4              3312                                                                               D                          D1C P      01990010120090101        N                           
A4617001003Mouth piece                                                                     Mouth piece                 00      960-4              3312                                                                               D                          D1C P      01990010120090101        N                           
A4618001003Breathing circuits                                                              Breathing circuits          32      A60-4              3312                                                                               D                          D1E APR    01990010119930101        N                           
A4619001003Face tent                                                                       Face tent                   32      A60-4              3312                                                                               D                          D1E P      01990010120110701        N                           
A4620001003Variable concentration mask                                                     Variable concentration mask 00      960-4              3312                                                                               D                          D1C P      01990010120090101        N                           
A4623001003Tracheostomy, inner cannula                                                     Tracheostomy inner cannula  37      A65-16             2130                                                                               D                          D1F P      01990010120040101        N                           
A4624001003Tracheal suction catheter, any type other than closed system, each              Tracheal suction tube       32      A                                                                                                     C                          D1E P      01990010120030101        N                           
A4625001003Tracheostomy care kit for new tracheostomy                                      Trach care kit for new trach37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A4626001003Tracheostomy cleaning brush, each                                               Tracheostomy cleaning brush 37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A4627001003Spacer, bag or reservoir, with or without mask, for use with metered dose       Spacer bag/reservoir        00      9                  2100                                                                               M                          D1A 9      01991010119970101        N                           
A4627002004inhaler                                                                                                                                                                                                                                                                                                              
A4628001003Oropharyngeal suction catheter, each                                            Oropharyngeal suction cath  32      A                                                                                                     C                          D1E APR    01996010119960101        N                           
A4629001003Tracheostomy care kit for established tracheostomy                              Tracheostomy care kit       37      A                  2130                                                                               D                          D1F P      01996010120030101        N                           
A4630001003Replacement batteries, medically necessary, transcutaneous electrical           Repl bat t.e.n.s. own by pt 32      A65-8                                                                                                 D                          D1E APR    01991010120060101        N                           
A4630002004stimulator, owned by patient                                                                                                                                                                                                                                                                                         
A4633001003Replacement bulb/lamp for ultraviolet light therapy system, each                Uvl replacement bulb        32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A4634001003Replacement bulb for therapeutic light box, tabletop model                      Replacement bulb th lightbox00      9                                                                                                     C                          D1E 9      02003010120030101        N                           
A4635001003Underarm pad, crutch, replacement, each                                         Underarm crutch pad         32      A60-9                                                                                                 D                          D1E APR    01991010119910101        N                           
A4636001003Replacement, handgrip, cane, crutch, or walker, each                            Handgrip for cane etc       32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N                           
A4637001003Replacement, tip, cane, crutch, walker, each.                                   Repl tip cane/crutch/walker 32      A60-9                                                                                                 D                          D1E APR    01991010119960101        N                           
A4638001003Replacement battery for patient-owned ear pulse generator, each                 Repl batt pulse gen sys     32      A                                                                                                     C                          D1E P      02004010120040101        N                           
A4639001003Replacement pad for infrared heating pad system, each                           Infrared ht sys replcmnt pad36      A                                                                                                     C                          D1E APR    02003010120140401        N                           
A4640001003Replacement pad for use with medically necessary alternating pressure pad owned Alternating pressure pad    32      A60-9              4107.6                                                                             D                          D1E APR    01991010119910101        N                           
A4640002004by patient                                                                                                                                                                                                                                                                                                           
A4641001003Radiopharmaceutical, diagnostic, not otherwise classified                       Radiopharm dx agent noc     51      A                                                                                                     C                          I1E 4      01994010120060101        N                           
A4642001003Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6          In111 satumomab             51      A                                                                                                     C                          I1E 4      01995010120060101        N                           
A4642002004millicuries                                                                                                                                                                                                                                                                                                          
A4648001003Tissue marker, implantable, any type, each                                      Implantable tissue marker   57      A                                                                                                     C                          I1E 9S     02008010120080101        N                           
A4649001003Surgical supply; miscellaneous                                                  Surgical supplies           46      A                                                                                                     C                          D1A 9      01982010119980101        N                           
A4650001003Implantable radiation dosimeter, each                                           Implant radiation dosimeter 57      A                                                                                                     C                          I1E 9S     02008010120080101        N                           
A4651001003Calibrated microcapillary tube, each                                            Calibrated microcap tube    00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4652001003Microcapillary tube sealant                                                     Microcapillary tube sealant 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4653001003Peritoneal dialysis catheter anchoring device, belt, each                       Pd catheter anchor belt     00      9                                                                                                     C                          P9B L      02003010120150101        N                           
A4657001003Syringe, with or without needle, each                                           Syringe w/wo needle         00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4660001003Sphygmomanometer/blood pressure apparatus with cuff and stethoscope             Sphyg/bp app w cuff and stet00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4663001003Blood pressure cuff only                                                        Dialysis blood pressure cuff00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4670001003Automatic blood pressure monitor                                                Automatic bp monitor, dial  00      950-42             4270                                                                               M                      0017P9B L      01986010120030101        N                           
A4671001003Disposable cycler set used with cycler dialysis machine, each                   Disposable cycler set       00      9                  4270                                                                               D                          P9B L      02004010120150101        N                           
A4672001003Drainage extension line, sterile, for dialysis, each                            Drainage ext line, dialysis 00      9                  4270                                                                               D                          P9B L      02004010120150101        N                           
A4673001003Extension line with easy lock connectors, used with dialysis                    Ext line w easy lock connect00      9                  4270                                                                               D                          P9B L      02004010120150101        N                           
A4674001003Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per  Chem/antisept solution, 8oz 00      9                  4270                                                                               D                          P9B L      02004010120150101        N                           
A46740020048 oz                                                                                                                                                                                                                                                                                                                 
A4680001003Activated carbon filter for hemodialysis, each                                  Activated carbon filter, ea 00      955-1              4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4690001003Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each     Dialyzer, each              00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4706001003Bicarbonate concentrate, solution, for hemodialysis, per gallon                 Bicarbonate conc sol per gal00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4707001003Bicarbonate concentrate, powder, for hemodialysis, per packet                   Bicarbonate conc pow per pac00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4708001003Acetate concentrate solution, for hemodialysis, per gallon                      Acetate conc sol per gallon 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4709001003Acid concentrate, solution, for hemodialysis, per gallon                        Acid conc sol per gallon    00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4714001003Treated water (deionized, distilled, or reverse osmosis) for peritoneal         Treated water per gallon    00      955-1              4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4714002004dialysis, per gallon                                                                                                                                                                                                                                                                                                 
A4719001003"y set" tubing for peritoneal dialysis                                          "y set" tubing              00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4720001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialysat sol fld vol > 249cc00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4720002004249 cc, but less than or equal to 999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                    
A4721001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialysat sol fld vol > 999cc00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4721002004999 cc but less than or equal to 1999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                    
A4722001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 1999cc 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A47220020041999 cc but less than or equal to 2999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                   
A4723001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 2999cc 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A47230020042999 cc but less than or equal to 3999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                   
A4724001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 3999cc 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A47240020043999 cc but less than or equal to 4999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                   
A4725001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 4999cc 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A47250020044999 cc but less than or equal to 5999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                   
A4726001003Dialysate solution, any concentration of dextrose, fluid volume greater than    Dialys sol fld vol > 5999cc 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A47260020045999 cc, for peritoneal dialysis                                                                                                                                                                                                                                                                                     
A4728001003Dialysate solution, non-dextrose containing, 500 ml                             Dialysate solution, non-dex 00      9                                                                                                     C                          P9B L      02004010120150101        N                           
A4730001003Fistula cannulation set for hemodialysis, each                                  Fistula cannulation set, ea 00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4736001003Topical anesthetic, for dialysis, per gram                                      Topical anesthetic, per gram00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4737001003Injectable anesthetic, for dialysis, per 10 ml                                  Inj anesthetic per 10 ml    00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4740001003Shunt accessory, for hemodialysis, any type, each                               Shunt accessory             00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4750001003Blood tubing, arterial or venous, for hemodialysis, each                        Art or venous blood tubing  00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4755001003Blood tubing, arterial and venous combined, for hemodialysis, each              Comb art/venous blood tubing00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4760001003Dialysate solution test kit, for peritoneal dialysis, any type, each            Dialysate sol test kit, each00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4765001003Dialysate concentrate, powder, additive for peritoneal dialysis, per packet     Dialysate conc pow per pack 00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4766001003Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml    Dialysate conc sol add 10 ml00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4770001003Blood collection tube, vacuum, for dialysis, per 50                             Blood collection tube/vacuum00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4771001003Serum clotting time tube, for dialysis, per 50                                  Serum clotting time tube    00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4772001003Blood glucose test strips, for dialysis, per 50                                 Blood glucose test strips   00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4773001003Occult blood test strips, for dialysis, per 50                                  Occult blood test strips    00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4774001003Ammonia test strips, for dialysis, per 50                                       Ammonia test strips         00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4802001003Protamine sulfate, for hemodialysis, per 50 mg                                  Protamine sulfate per 50 mg 00      9                  4270                                                                               D                      0017P9B L      02002010120150101        N                           
A4860001003Disposable catheter tips for peritoneal dialysis, per 10                        Disposable catheter tips    00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4870001003Plumbing and/or electrical work for home hemodialysis equipment                 Plumb/elec wk hm hemo equip 00      9                  4270                                                                               D                      0017P9B L      01986010120150101        N                           
A4890001003Contracts, repair and maintenance, for hemodialysis equipment                   Repair/maint cont hemo equip00      9                  2100.4                                                                             D                      0017P9B L      01986010120150101        N                           
A4911001003Drain bag/bottle, for dialysis, each                                            Drain bag/bottle            00      9                                                                                                     D                      0017P9B L      02002010120150101        N                           
A4913001003Miscellaneous dialysis supplies, not otherwise specified                        Misc dialysis supplies noc  00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
A4918001003Venous pressure clamp, for hemodialysis, each                                   Venous pressure clamp       00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
A4927001003Gloves, non-sterile, per 100                                                    Non-sterile gloves          00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
A4928001003Surgical mask, per 20                                                           Surgical mask               00      9                                                                                                     D                      0017P9B L      02002010120150101        N                           
A4929001003Tourniquet for dialysis, each                                                   Tourniquet for dialysis, ea 00      9                                                                                                     D                      0017P9B L      02002010120150101        N                           
A4930001003Gloves, sterile, per pair                                                       Sterile, gloves per pair    00      9                                                                                                     D                      0017P9B L      02003010120150101        N                           
A4931001003Oral thermometer, reusable, any type, each                                      Reusable oral thermometer   00      9                                                                                                     C                          P9B L      02003010120150101        N                           
A4932001003Rectal thermometer, reusable, any type, each                                    Reusable rectal thermometer 00      9                                                                                                     C                          Z2  9      02003010120070101        N                           
A5051001003Ostomy pouch, closed; with barrier attached (1 piece), each                     Pouch clsd w barr attached  37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5052001003Ostomy pouch, closed; without barrier attached (1 piece), each                  Clsd ostomy pouch w/o barr  37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5053001003Ostomy pouch, closed; for use on faceplate, each                                Clsd ostomy pouch faceplate 37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5054001003Ostomy pouch, closed; for use on barrier with flange (2 piece), each            Clsd ostomy pouch w/flange  37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5055001003Stoma cap                                                                       Stoma cap                   37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5056001003Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1   1 pc ost pouch w filter     37      A                  2130                                                                               D                          D1F P      02012010120120101        N                           
A5056002004piece), each                                                                                                                                                                                                                                                                                                         
A5057001003Ostomy pouch, drainable, with extended wear barrier attached, with built in     1 pc ost pou w built-in conv37      A                  2130                                                                               D                          D1F P      02012010120120101        N                           
A5057002004convexity, with filter, (1 piece), each                                                                                                                                                                                                                                                                              
A5061001003Ostomy pouch, drainable; with barrier attached, (1 piece), each                 Pouch drainable w barrier at37      A                                                                                                     C                          D1F P      01990010120030101        N                           
A5062001003Ostomy pouch, drainable; without barrier attached (1 piece), each               Drnble ostomy pouch w/o barr37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5063001003Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each  Drain ostomy pouch w/flange 37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5071001003Ostomy pouch, urinary; with barrier attached (1 piece), each                    Urinary pouch w/barrier     37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5072001003Ostomy pouch, urinary; without barrier attached (1 piece), each                 Urinary pouch w/o barrier   37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5073001003Ostomy pouch, urinary; for use on barrier with flange (2 piece), each           Urinary pouch on barr w/flng37      A                  2130                                                                               D                          D1F P      01990010120030101        N                           
A5081001003Stoma plug or seal, any type                                                    Stoma plug or seal, any type37      A                  2130                                                                               D                          D1F P      01990010120140101        N                           
A5082001003Continent device; catheter for continent stoma                                  Continent stoma catheter    37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5083001003Continent device, stoma absorptive cover for continent stoma                    Stoma absorptive cover      37      A                                                                                                     C                          D1F P      02008010120080101        N                           
A5093001003Ostomy accessory; convex insert                                                 Ostomy accessory convex inse37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5102001003Bedside drainage bottle with or without tubing, rigid or expandable, each       Bedside drain btl w/wo tube 37      A                  2130                                                                               D                          D1F P      01990010119970101        N                           
A5105001003Urinary suspensory with leg bag, with or without tube, each                     Urinary suspensory          37      A                  2130                                                                               D                          D1F P      01990010120080101        N                           
A5112001003Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, Urinary leg bag             37      A                  2130                                                                               D                          D1F P      01990010120110101        N                           
A5112002004each                                                                                                                                                                                                                                                                                                                 
A5113001003Leg strap; latex, replacement only, per set                                     Latex leg strap             37      A                  2130                                                                               D                          D1F P      01990010119980101        N                           
A5114001003Leg strap; foam or fabric, replacement only, per set                            Foam/fabric leg strap       37      A                  2130                                                                               D                          D1F P      01990010119980101        N                           
A5120001003Skin barrier, wipes or swabs, each                                              Skin barrier, wipe or swab  37      A                  2130                                                                               D                          D1F P      02006010120060101        N                           
A5121001003Skin barrier; solid, 6 x 6 or equivalent, each                                  Solid skin barrier 6x6      37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5122001003Skin barrier; solid, 8 x 8 or equivalent, each                                  Solid skin barrier 8x8      37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5126001003Adhesive or non-adhesive; disk or foam pad                                      Disk/foam pad +or- adhesive 37      A                  2130                                                                               D                          D1F P      01990010120000101        N                           
A5131001003Appliance cleaner, incontinence and ostomy appliances, per 16 oz.               Appliance cleaner           37      A                  2130                                                                               D                          D1F P      01990010119900101        N                           
A5200001003Percutaneous catheter/tube anchoring device, adhesive skin attachment           Percutaneous catheter anchor37      A                  2130                                                                               D                          D1F P      01999010120030101        N                           
A5500001003For diabetics only, fitting (including follow-up), custom preparation and       Diab shoe for density insert38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5500002004supply of off-the-shelf depth-inlay shoe manufactured to accommodate                                                                                                                                                                                                                                                 
A5500003004multi-density insert(s), per shoe                                                                                                                                                                                                                                                                                    
A5501001003For diabetics only, fitting (including follow-up), custom preparation and       Diabetic custom molded shoe 38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5501002004supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per                                                                                                                                                                                                                                       
A5501003004shoe                                                                                                                                                                                                                                                                                                                 
A5503001003For diabetics only, modification (including fitting) of off-the-shelf           Diabetic shoe w/roller/rockr38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5503002004depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per                                                                                                                                                                                                                                       
A5503003004shoe                                                                                                                                                                                                                                                                                                                 
A5504001003For diabetics only, modification (including fitting) of off-the-shelf           Diabetic shoe with wedge    38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5504002004depth-inlay shoe or custom-molded shoe with wedge(s), per shoe                                                                                                                                                                                                                                                       
A5505001003For diabetics only, modification (including fitting) of off-the-shelf           Diab shoe w/metatarsal bar  38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5505002004depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe                                                                                                                                                                                                                                                 
A5506001003For diabetics only, modification (including fitting) of off-the-shelf           Diabetic shoe w/off set heel38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5506002004depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe                                                                                                                                                                                                                                                
A5507001003For diabetics only, not otherwise specified modification (including fitting) of Modification diabetic shoe  38      A                  2134                                                                               D                          D1F J      01995010120050101        N                           
A5507002004off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe                                                                                                                                                                                                                                                       
A5508001003For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or         Diabetic deluxe shoe        38      A                  2134                                                                               D                          D1F J      02000010120050101        N                           
A5508002004custom-molded shoe, per shoe                                                                                                                                                                                                                                                                                         
A5510001003For diabetics only, direct formed, compression molded to patient's foot without Compression form shoe insert38      A                  2134                                                                               D                          D1F J      02002010120050101        N                           
A5510002004external heat source, multiple-density insert(s) prefabricated, per shoe                                                                                                                                                                                                                                             
A5512001003For diabetics only, multiple density insert, direct formed, molded to foot      Multi den insert direct form38      A                  2134                                                                               D                          D1F J      02006010120190101        F                           
A5512002004after external heat source of 230 degrees fahrenheit or higher, total contact                                                                                                                                                                                                                                        
A5512003004with patient's foot, including arch, base layer minimum of 1/4 inch material of                                                                                                                                                                                                                                      
A5512004004shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher),                                                                                                                                                                                                                                      
A5512005004prefabricated, each                                                                                                                                                                                                                                                                                                  
A5513001003For diabetics only, multiple density insert, custom molded from model of        Multi den insert custom mold38      A                  2134                                                                               D                          D1F J      020060101                B                           
A5513002004patient's foot, total contact with patient's foot, including arch, base layer                                                                                                                                                                                                                                        
A5513003004minimum of 3/16 inch material of shore a 35 durometer (or higher), includes                                                                                                                                                                                                                                          
A5513004004arch filler and other shaping material, custom fabricated, each                                                                                                                                                                                                                                                      
A5514001003For diabetics only, multiple density insert, made by direct carving with cam    Mult den insert dir carv/cam38      A                  2134                                                                               D                          D1F J      02019010120190101        A                           
A5514002004technology from a rectified cad model created from a digitized scan of the                                                                                                                                                                                                                                           
A5514003004patient, total contact with patient's foot, including arch, base layer minimum                                                                                                                                                                                                                                       
A5514004004of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler                                                                                                                                                                                                                                      
A5514005004and other shaping material, custom fabricated, each                                                                                                                                                                                                                                                                  
A6000001003Non-contact wound warming wound cover for use with the non-contact wound        Wound warming wound cover   00      9                  2303                                                                               M                          D1E P      02002010120020701        N                           
A6000002004warming device and warming card                                                                                                                                                                                                                                                                                      
A6010001003Collagen based wound filler, dry form, sterile, per gram of collagen            Collagen based wound filler 35      A                  2079                                                                               D                          D1A S      02002010120090101        N                           
A6011001003Collagen based wound filler, gel/paste, per gram of collagen                    Collagen gel/paste wound fil35      A                  2079                                                                               D                          D1A S      02003010120110101        N                           
A6021001003Collagen dressing, sterile, size 16 sq. in. or less, each                       Collagen dressing <=16 sq in35      A                  2079                                                                               D                          D1A S      02001010120130101        N                           
A6022001003Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to Collagen drsg>16<=48 sq in  35      A                  2079                                                                               D                          D1A S      02001010120130101        N                           
A602200200448 sq. in., each                                                                                                                                                                                                                                                                                                     
A6023001003Collagen dressing, sterile, size more than 48 sq. in., each                     Collagen dressing >48 sq in 35      A                  2079                                                                               D                          D1A S      02001010120130101        N                           
A6024001003Collagen dressing wound filler, sterile, per 6 inches                           Collagen dsg wound filler   35      A                  2079                                                                               D                          D1A S      02001010120090101        N                           
A6025001003Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel,       Silicone gel sheet, each    00      9                                                                                                     C                          D1A 9      01997010120070101        N                           
A6025002004other), each                                                                                                                                                                                                                                                                                                         
A6154001003Wound pouch, each                                                               Wound pouch each            35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6196001003Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. Alginate dressing <=16 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6196002004in. or less, each dressing                                                                                                                                                                                                                                                                                           
A6197001003Alginate or other fiber gelling dressing, wound cover, sterile, pad size more   Alginate drsg >16 <=48 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6197002004than 16 sq. in. but less than or equal to 48 sq. in., each dressing                                                                                                                                                                                                                                                  
A6198001003Alginate or other fiber gelling dressing, wound cover, sterile, pad size more   Alginate dressing > 48 sq in46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6198002004than 48 sq. in., each dressing                                                                                                                                                                                                                                                                                       
A6199001003Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   Alginate drsg wound filler  35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6203001003Composite dressing, sterile, pad size 16 sq. in. or less, with any size         Composite drsg <= 16 sq in  35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6203002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6204001003Composite dressing, sterile, pad size more than 16 sq. in. but less than or     Composite drsg >16<=48 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6204002004equal to 48 sq. in., with any size adhesive border, each dressing                                                                                                                                                                                                                                                    
A6205001003Composite dressing, sterile, pad size more than 48 sq. in., with any size       Composite drsg > 48 sq in   46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6205002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6206001003Contact layer, sterile, 16 sq. in. or less, each dressing                       Contact layer <= 16 sq in   46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6207001003Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq.   Contact layer >16<= 48 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6207002004in., each dressing                                                                                                                                                                                                                                                                                                   
A6208001003Contact layer, sterile, more than 48 sq. in., each dressing                     Contact layer > 48 sq in    46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6209001003Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without       Foam drsg <=16 sq in w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6209002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6210001003Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less     Foam drg >16<=48 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6210002004than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                                  
A6211001003Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without     Foam drg > 48 sq in w/o brdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6211002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6212001003Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size Foam drg <=16 sq in w/border35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6212002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6213001003Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less     Foam drg >16<=48 sq in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6213002004than or equal to 48 sq. in., with any size adhesive border, each dressing                                                                                                                                                                                                                                            
A6214001003Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any    Foam drg > 48 sq in w/border35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6214002004size adhesive border, each dressing                                                                                                                                                                                                                                                                                  
A6215001003Foam dressing, wound filler, sterile, per gram                                  Foam dressing wound filler  46      A                  2079                                                                               D                          D1A LS     01997010120090101        N                           
A6216001003Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without       Non-sterile gauze<=16 sq in 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6216002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6217001003Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less     Non-sterile gauze>16<=48 sq 35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6217002004than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                                  
A6218001003Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without     Non-sterile gauze > 48 sq in46      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6218002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6219001003Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size     Gauze <= 16 sq in w/border  35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6219002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6220001003Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or Gauze >16 <=48 sq in w/bordr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6220002004equal to 48 sq. in., with any size adhesive border, each dressing                                                                                                                                                                                                                                                    
A6221001003Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size   Gauze > 48 sq in w/border   46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6221002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6222001003Gauze, impregnated with other than water, normal saline, or hydrogel, sterile,  Gauze <=16 in no w/sal w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6222002004pad size 16 sq. in. or less, without adhesive border, each dressing                                                                                                                                                                                                                                                  
A6223001003Gauze, impregnated with other than water, normal saline, or hydrogel, sterile,  Gauze >16<=48 no w/sal w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6223002004pad size more than 16 sq. in., but less than or equal to 48 sq. in., without                                                                                                                                                                                                                                         
A6223003004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6224001003Gauze, impregnated with other than water, normal saline, or hydrogel, sterile,  Gauze > 48 in no w/sal w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6224002004pad size more than 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                                
A6228001003Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or     Gauze <= 16 sq in water/sal 46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6228002004less, without adhesive border, each dressing                                                                                                                                                                                                                                                                         
A6229001003Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq.  Gauze >16<=48 sq in watr/sal35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6229002004in. but less than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                     
A6230001003Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq.  Gauze > 48 sq in water/salne46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6230002004in., without adhesive border, each dressing                                                                                                                                                                                                                                                                          
A6231001003Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16    Hydrogel dsg<=16 sq in      35      A                  2079                                                                               D                          D1A S      02001010120090101        N                           
A6231002004sq. in. or less, each dressing                                                                                                                                                                                                                                                                                       
A6232001003Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size       Hydrogel dsg>16<=48 sq in   35      A                  2079                                                                               D                          D1A S      02001010120090101        N                           
A6232002004greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing                                                                                                                                                                                                                                         
A6233001003Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more  Hydrogel dressing >48 sq in 35      A                  2079                                                                               D                          D1A S      02001010120090101        N                           
A6233002004than 48 sq. in., each dressing                                                                                                                                                                                                                                                                                       
A6234001003Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less,       Hydrocolld drg <=16 w/o bdr 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6234002004without adhesive border, each dressing                                                                                                                                                                                                                                                                               
A6235001003Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but  Hydrocolld drg >16<=48 w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6235002004less than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                             
A6236001003Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in.,     Hydrocolld drg > 48 in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6236002004without adhesive border, each dressing                                                                                                                                                                                                                                                                               
A6237001003Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with  Hydrocolld drg <=16 in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6237002004any size adhesive border, each dressing                                                                                                                                                                                                                                                                              
A6238001003Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but  Hydrocolld drg >16<=48 w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6238002004less than or equal to 48 sq. in., with any size adhesive border, each dressing                                                                                                                                                                                                                                       
A6239001003Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in.,     Hydrocolld drg > 48 in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6239002004with any size adhesive border, each dressing                                                                                                                                                                                                                                                                         
A6240001003Hydrocolloid dressing, wound filler, paste, sterile, per ounce                  Hydrocolld drg filler paste 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6241001003Hydrocolloid dressing, wound filler, dry form, sterile, per gram                Hydrocolloid drg filler dry 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6242001003Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without   Hydrogel drg <=16 in w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6242002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6243001003Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less Hydrogel drg >16<=48 w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6243002004than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                                  
A6244001003Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without Hydrogel drg >48 in w/o bdr 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6244002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6245001003Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any  Hydrogel drg <= 16 in w/bdr 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6245002004size adhesive border, each dressing                                                                                                                                                                                                                                                                                  
A6246001003Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less Hydrogel drg >16<=48 in w/b 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6246002004than or equal to 48 sq. in., with any size adhesive border, each dressing                                                                                                                                                                                                                                            
A6247001003Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with    Hydrogel drg > 48 sq in w/b 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6247002004any size adhesive border, each dressing                                                                                                                                                                                                                                                                              
A6248001003Hydrogel dressing, wound filler, gel, per fluid ounce                           Hydrogel drsg gel filler    35      A                  2079                                                                               D                          D1A S      01997010120110101        N                           
A6250001003Skin sealants, protectants, moisturizers, ointments, any type, any size         Skin seal protect moisturizr00      9                  2079                                                                               D                          D1A LS     01997010120030101        N                           
A6251001003Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or     Absorpt drg <=16 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6251002004less, without adhesive border, each dressing                                                                                                                                                                                                                                                                         
A6252001003Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq.  Absorpt drg >16 <=48 w/o bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6252002004in. but less than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                     
A6253001003Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq.  Absorpt drg > 48 sq in w/o b35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6253002004in., without adhesive border, each dressing                                                                                                                                                                                                                                                                          
A6254001003Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or     Absorpt drg <=16 sq in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6254002004less, with any size adhesive border, each dressing                                                                                                                                                                                                                                                                   
A6255001003Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq.  Absorpt drg >16<=48 in w/bdr35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6255002004in. but less than or equal to 48 sq. in., with any size adhesive border, each                                                                                                                                                                                                                                        
A6255003004dressing                                                                                                                                                                                                                                                                                                             
A6256001003Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq.  Absorpt drg > 48 sq in w/bdr46      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6256002004in., with any size adhesive border, each dressing                                                                                                                                                                                                                                                                    
A6257001003Transparent film, sterile, 16 sq. in. or less, each dressing                    Transparent film <= 16 sq in35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6258001003Transparent film, sterile, more than 16 sq. in. but less than or equal to 48    Transparent film >16<=48 in 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6258002004sq. in., each dressing                                                                                                                                                                                                                                                                                               
A6259001003Transparent film, sterile, more than 48 sq. in., each dressing                  Transparent film > 48 sq in 35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6260001003Wound cleansers, any type, any size                                             Wound cleanser any type/size00      9                  2079                                                                               D                          D1A LS     01997010120110101        N                           
A6261001003Wound filler, gel/paste, per fluid ounce, not otherwise specified               Wound filler gel/paste /oz  46      A                  2079                                                                               D                          D1A S      01997010120110101        N                           
A6262001003Wound filler, dry form, per gram, not otherwise specified                       Wound filler dry form / gram46      A                  2079                                                                               D                          D1A S      01997010120110101        N                           
A6266001003Gauze, impregnated, other than water, normal saline, or zinc paste, sterile,    Impreg gauze no h20/sal/yard35      A                  2079                                                                               D                          D1A S      01997010120090101        N                           
A6266002004any width, per linear yard                                                                                                                                                                                                                                                                                           
A6402001003Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive  Sterile gauze <= 16 sq in   35      A                  2079                                                                               D                          D1A LS     01997010120060101        N                           
A6402002004border, each dressing                                                                                                                                                                                                                                                                                                
A6403001003Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or     Sterile gauze>16 <= 48 sq in35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6403002004equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                                          
A6404001003Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without         Sterile gauze > 48 sq in    35      A                  2079                                                                               D                          D1A S      01997010120030101        N                           
A6404002004adhesive border, each dressing                                                                                                                                                                                                                                                                                       
A6407001003Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear   Packing strips, non-impreg  35      A                                                                                                     C                          D1A S      02004010120090101        N                           
A6407002004yard                                                                                                                                                                                                                                                                                                                 
A6410001003Eye pad, sterile, each                                                          Sterile eye pad             35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6411001003Eye pad, non-sterile, each                                                      Non-sterile eye pad         35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6412001003Eye patch, occlusive, each                                                      Occlusive eye patch         00      9                                                                                                     C                          Z2  S      02003010120070101        N                           
A6413001003Adhesive bandage, first-aid type, any size, each                                Adhesive bandage, first-aid 00      9                                          1861(s)(5)                                                 S                          D1A P      02008010120080101        N                           
A6441001003Padding bandage, non-elastic, non-woven/non-knitted, width greater than or      Pad band w>=3" <5"/yd       35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6441002004equal to three inches and less than five inches, per yard                                                                                                                                                                                                                                                            
A6442001003Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than    Conform band n/s w<3"/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6442002004three inches, per yard                                                                                                                                                                                                                                                                                               
A6443001003Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than Conform band n/s w>=3"<5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6443002004or equal to three inches and less than five inches, per yard                                                                                                                                                                                                                                                         
A6444001003Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than Conform band n/s w>=5"/yd   35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6444002004or equal to 5 inches, per yard                                                                                                                                                                                                                                                                                       
A6445001003Conforming bandage, non-elastic, knitted/woven, sterile, width less than three  Conform band s w <3"/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6445002004inches, per yard                                                                                                                                                                                                                                                                                                     
A6446001003Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or  Conform band s w>=3" <5"/yd 35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6446002004equal to three inches and less than five inches, per yard                                                                                                                                                                                                                                                            
A6447001003Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or  Conform band s w >=5"/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6447002004equal to five inches, per yard                                                                                                                                                                                                                                                                                       
A6448001003Light compression bandage, elastic, knitted/woven, width less than three        Lt compres band <3"/yd      35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6448002004inches, per yard                                                                                                                                                                                                                                                                                                     
A6449001003Light compression bandage, elastic, knitted/woven, width greater than or equal  Lt compres band >=3" <5"/yd 35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6449002004to three inches and less than five inches, per yard                                                                                                                                                                                                                                                                  
A6450001003Light compression bandage, elastic, knitted/woven, width greater than or equal  Lt compres band >=5"/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6450002004to five inches, per yard                                                                                                                                                                                                                                                                                             
A6451001003Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25   Mod compres band w>=3"<5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6451002004to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to                                                                                                                                                                                                                                           
A6451003004three inches and less than five inches, per yard                                                                                                                                                                                                                                                                     
A6452001003High compression bandage, elastic, knitted/woven, load resistance greater than  High compres band w>=3"<5"yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6452002004or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or                                                                                                                                                                                                                                           
A6452003004equal to three inches and less than five inches, per yard                                                                                                                                                                                                                                                            
A6453001003Self-adherent bandage, elastic, non-knitted/non-woven, width less than three    Self-adher band w <3"/yd    35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6453002004inches, per yard                                                                                                                                                                                                                                                                                                     
A6454001003Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or    Self-adher band w>=3" <5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6454002004equal to three inches and less than five inches, per yard                                                                                                                                                                                                                                                            
A6455001003Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or    Self-adher band >=5"/yd     35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6455002004equal to five inches, per yard                                                                                                                                                                                                                                                                                       
A6456001003Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than  Zinc paste band w >=3"<5"/yd35      A                                                                                                     C                          D1A S      02004010120040101        N                           
A6456002004or equal to three inches and less than five inches, per yard                                                                                                                                                                                                                                                         
A6457001003Tubular dressing with or without elastic, any width, per linear yard            Tubular dressing            35      A                                                                                                     C                          D1A S      02006010120060101        N                           
A6460001003Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less,      Synthetic drsg <= 16 sq in  35      A                                                                                                     C                          D1A S      02019010120190101        A                           
A6460002004without adhesive border, each dressing                                                                                                                                                                                                                                                                               
A6461001003Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but Synthetic drsg >16<=48 sq in35      A                                                                                                     C                          D1A S      02019010120190101        A                           
A6461002004less than or equal to 48 sq. in., without adhesive border, each dressing                                                                                                                                                                                                                                             
A6501001003Compression burn garment, bodysuit (head to foot), custom fabricated            Compres burngarment bodysuit35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6502001003Compression burn garment, chin strap, custom fabricated                         Compres burngarment chinstrp35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6503001003Compression burn garment, facial hood, custom fabricated                        Compres burngarment facehood35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6504001003Compression burn garment, glove to wrist, custom fabricated                     Cmprsburngarment glove-wrist35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6505001003Compression burn garment, glove to elbow, custom fabricated                     Cmprsburngarment glove-elbow35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6506001003Compression burn garment, glove to axilla, custom fabricated                    Cmprsburngrmnt glove-axilla 35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6507001003Compression burn garment, foot to knee length, custom fabricated                Cmprs burngarment foot-knee 35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6508001003Compression burn garment, foot to thigh length, custom fabricated               Cmprs burngarment foot-thigh35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6509001003Compression burn garment, upper trunk to waist including arm openings (vest),   Compres burn garment jacket 35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6509002004custom fabricated                                                                                                                                                                                                                                                                                                    
A6510001003Compression burn garment, trunk, including arms down to leg openings (leotard), Compres burn garment leotard35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6510002004custom fabricated                                                                                                                                                                                                                                                                                                    
A6511001003Compression burn garment, lower trunk including leg openings (panty), custom    Compres burn garment panty  35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6511002004fabricated                                                                                                                                                                                                                                                                                                           
A6512001003Compression burn garment, not otherwise classified                              Compres burn garment, noc   35      A                  2079                                                                               D                          D1A S      02003010120030101        N                           
A6513001003Compression burn mask, face and/or neck, plastic or equal, custom fabricated    Compress burn mask face/neck00      9                                                                                                     C                          D1A P      02006010120060101        N                           
A6530001003Gradient compression stocking, below knee, 18-30 mmhg, each                     Compression stocking bk18-3000      960-9                                                                                                 M                      0072D1A P      02006010120110101        N                           
A6531001003Gradient compression stocking, below knee, 30-40 mmhg, each                     Compression stocking bk30-4035      A                  2079                                                                               D                      0072D1A PS     02006010120060101        N                           
A6532001003Gradient compression stocking, below knee, 40-50 mmhg, each                     Compression stocking bk40-5035      A                  2079                                                                               D                      0072D1A PS     02006010120060101        N                           
A6533001003Gradient compression stocking, thigh length, 18-30 mmhg, each                   Gc stocking thighlngth 18-3000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6534001003Gradient compression stocking, thigh length, 30-40 mmhg, each                   Gc stocking thighlngth 30-4000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6535001003Gradient compression stocking, thigh length, 40-50 mmhg, each                   Gc stocking thighlngth 40-5000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6536001003Gradient compression stocking, full length/chap style, 18-30 mmhg, each         Gc stocking full lngth 18-3000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6537001003Gradient compression stocking, full length/chap style, 30-40 mmhg, each         Gc stocking full lngth 30-4000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6538001003Gradient compression stocking, full length/chap style, 40-50 mmhg, each         Gc stocking full lngth 40-5000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6539001003Gradient compression stocking, waist length, 18-30 mmhg, each                   Gc stocking waistlngth 18-3000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6540001003Gradient compression stocking, waist length, 30-40 mmhg, each                   Gc stocking waistlngth 30-4000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6541001003Gradient compression stocking, waist length, 40-50 mmhg, each                   Gc stocking waistlngth 40-5000      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6544001003Gradient compression stocking, garter belt                                      Gc stocking garter belt     00      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6545001003Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each           Grad comp non-elastic bk    35      A                  2079                                                                               D                          D1A PS     02009010120110101        N                           
A6549001003Gradient compression stocking/sleeve, not otherwise specified                   G compression stocking      00      960-9              2133                                                                               M                      0072D1A P      02006010120110101        N                           
A6550001003Wound care set, for negative pressure wound therapy electrical pump, includes   Neg pres wound ther drsg set34      A                                                                                                     C                          D1E P      02004010120060101        N                           
A6550002004all supplies and accessories                                                                                                                                                                                                                                                                                         
A7000001003Canister, disposable, used with suction pump, each                              Disposable canister for pump32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7001001003Canister, non-disposable, used with suction pump, each                          Nondisposable pump canister 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7002001003Tubing, used with suction pump, each                                            Tubing used w suction pump  32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7003001003Administration set, with small volume nonfiltered pneumatic nebulizer,          Nebulizer administration set32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7003002004disposable                                                                                                                                                                                                                                                                                                           
A7004001003Small volume nonfiltered pneumatic nebulizer, disposable                        Disposable nebulizer sml vol32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7005001003Administration set, with small volume nonfiltered pneumatic nebulizer,          Nondisposable nebulizer set 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7005002004non-disposable                                                                                                                                                                                                                                                                                                       
A7006001003Administration set, with small volume filtered pneumatic nebulizer              Filtered nebulizer admin set32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7007001003Large volume nebulizer, disposable, unfilled, used with aerosol compressor      Lg vol nebulizer disposable 32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7008001003Large volume nebulizer, disposable, prefilled, used with aerosol compressor     Disposable nebulizer prefill32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7009001003Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer   Nebulizer reservoir bottle  32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7010001003Corrugated tubing, disposable, used with large volume nebulizer, 100 feet       Disposable corrugated tubing32      A                                                                                                     C                          D1E P      02000010120000101        N                           
A7011001003Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet    Nondispos corrugated tubing 46      A                                                                                                     C                          D1E P      0200001012016010120151231N                           
A7012001003Water collection device, used with large volume nebulizer                       Nebulizer water collec devic32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7013001003Filter, disposable, used with aerosol compressor or ultrasonic generator        Disposable compressor filter32      A                                                                                                     C                          D1E P      02000010120110101        N                           
A7014001003Filter, nondisposable, used with aerosol compressor or ultrasonic generator     Compressor nondispos filter 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7015001003Aerosol mask, used with dme nebulizer                                           Aerosol mask used w nebulize32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7016001003Dome and mouthpiece, used with small volume ultrasonic nebulizer                Nebulizer dome & mouthpiece 32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
A7017001003Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with   Nebulizer not used w oxygen 32      A60-9                                                                                                 D                          D1E APR    02000010120000101        N                           
A7017002004oxygen                                                                                                                                                                                                                                                                                                               
A7018001003Water, distilled, used with large volume nebulizer, 1000 ml                     Water distilled w/nebulizer 32      A                                                                                                     C                          D1E P      02001010120010101        N                           
A7020001003Interface for cough stimulating device, includes all components, replacement    Interface, cough stim device32      A                                                                                                     C                          D1E R      02011010120110101        N                           
A7020002004only                                                                                                                                                                                                                                                                                                                 
A7025001003High frequency chest wall oscillation system vest, replacement for use with     Replace chest compress vest 36      A                                                                                                     C                          D1E APR    02003010120140401        N                           
A7025002004patient owned equipment, each                                                                                                                                                                                                                                                                                        
A7026001003High frequency chest wall oscillation system hose, replacement for use with     Replace chst cmprss sys hose32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7026002004patient owned equipment, each                                                                                                                                                                                                                                                                                        
A7027001003Combination oral/nasal mask, used with continuous positive airway pressure      Combination oral/nasal mask 32      A                                                                                                     C                          D1E APR    02008010120080101        N                           
A7027002004device, each                                                                                                                                                                                                                                                                                                         
A7028001003Oral cushion for combination oral/nasal mask, replacement only, each            Repl oral cushion combo mask32      A                                                                                                     C                          D1E APR    02008010120080101        N                           
A7029001003Nasal pillows for combination oral/nasal mask, replacement only, pair           Repl nasal pillow comb mask 32      A                                                                                                     C                          D1E APR    02008010120080101        N                           
A7030001003Full face mask used with positive airway pressure device, each                  Cpap full face mask         32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7031001003Face mask interface, replacement for full face mask, each                       Replacement facemask interfa32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7032001003Cushion for use on nasal mask interface, replacement only, each                 Replacement nasal cushion   32      A                                                                                                     C                          D1E APR    02003010120060101        N                           
A7033001003Pillow for use on nasal cannula type interface, replacement only, pair          Replacement nasal pillows   32      A                                                                                                     C                          D1E APR    02003010120060101        N                           
A7034001003Nasal interface (mask or cannula type) used with positive airway pressure       Nasal application device    32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7034002004device, with or without head strap                                                                                                                                                                                                                                                                                   
A7035001003Headgear used with positive airway pressure device                              Pos airway press headgear   32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7036001003Chinstrap used with positive airway pressure device                             Pos airway press chinstrap  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7037001003Tubing used with positive airway pressure device                                Pos airway pressure tubing  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7038001003Filter, disposable, used with positive airway pressure device                   Pos airway pressure filter  32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7039001003Filter, non disposable, used with positive airway pressure device               Filter, non disposable w pap32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7040001003One way chest drain valve                                                       One way chest drain valve   38      A                                                                                                     C                          D1F P      02005010120050101        N                           
A7041001003Water seal drainage container and tubing for use with implanted chest tube      Water seal drain container  38      A                                                                                                     C                          D1F P      02005010120050101        N                           
A7042001003Implanted pleural catheter, each                                                Implanted pleural catheter  38      A                                                                                                     C                          D1F P      0200301012015010120141231N                           
A7043001003Vacuum drainage bottle and tubing for use with implanted catheter               Vacuum drainagebottle/tubing38      A                                                                                                     C                          D1F P      0200301012015010120141231N                           
A7044001003Oral interface used with positive airway pressure device, each                  Pap oral interface          32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
A7045001003Exhalation port with or without swivel used with accessories for positive       Repl exhalation port for pap32      A60-17                                                                                                D                          D1E APR    02005010120050101        N                           
A7045002004airway devices, replacement only                                                                                                                                                                                                                                                                                     
A7046001003Water chamber for humidifier, used with positive airway pressure device,        Repl water chamber, pap dev 32      A60-17                                                                                                D                          D1E P      02004010120040101        N                           
A7046002004replacement, each                                                                                                                                                                                                                                                                                                    
A7047001003Oral interface used with respiratory suction pump, each                         Resp suction oral interface 32      A                                                                                                     C                          D1E APR    02014010120140101        N                           
A7048001003Vacuum drainage collection unit and tubing kit, including all supplies needed   Vacuum drain bottle/tube kit38      A                                                                                                     C                          D1F P      02015010120150101        N                           
A7048002004for collection unit change, for use with implanted catheter, each                                                                                                                                                                                                                                                    
A7501001003Tracheostoma valve, including diaphragm, each                                   Tracheostoma valve w diaphra37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7502001003Replacement diaphragm/faceplate for tracheostoma valve, each                    Replacement diaphragm/fplate37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7503001003Filter holder or filter cap, reusable, for use in a tracheostoma heat and       Hmes filter holder or cap   37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7503002004moisture exchange system, each                                                                                                                                                                                                                                                                                       
A7504001003Filter for use in a tracheostoma heat and moisture exchange system, each        Tracheostoma hmes filter    37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7505001003Housing, reusable without adhesive, for use in a heat and moisture exchange     Hmes or trach valve housing 37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7505002004system and/or with a tracheostoma valve, each                                                                                                                                                                                                                                                                        
A7506001003Adhesive disc for use in a heat and moisture exchange system and/or with        Hmes/trachvalve adhesivedisk37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7506002004tracheostoma valve, any type each                                                                                                                                                                                                                                                                                    
A7507001003Filter holder and integrated filter without adhesive, for use in a tracheostoma Integrated filter & holder  37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7507002004heat and moisture exchange system, each                                                                                                                                                                                                                                                                              
A7508001003Housing and integrated adhesive, for use in a tracheostoma heat and moisture    Housing & integrated adhesiv37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7508002004exchange system and/or with a tracheostoma valve, each                                                                                                                                                                                                                                                               
A7509001003Filter holder and integrated filter housing, and adhesive, for use as a         Heat & moisture exchange sys37      A                  2130                                                                               D                          D1F P      02001010120010101        N                           
A7509002004tracheostoma heat and moisture exchange system, each                                                                                                                                                                                                                                                                 
A7520001003Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone   Trach/laryn tube non-cuffed 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7520002004or equal, each                                                                                                                                                                                                                                                                                                       
A7521001003Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or    Trach/laryn tube cuffed     37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7521002004equal, each                                                                                                                                                                                                                                                                                                          
A7522001003Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and      Trach/laryn tube stainless  37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7522002004reusable), each                                                                                                                                                                                                                                                                                                      
A7523001003Tracheostomy shower protector, each                                             Tracheostomy shower protect 37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7524001003Tracheostoma stent/stud/button, each                                            Tracheostoma stent/stud/bttn37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7525001003Tracheostomy mask, each                                                         Tracheostomy mask           37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7526001003Tracheostomy tube collar/holder, each                                           Tracheostomy tube collar    37      A                                                                                                     C                          D1F P      02004010120040101        N                           
A7527001003Tracheostomy/laryngectomy tube plug/stop, each                                  Trach/laryn tube plug/stop  37      A                                                                                                     C                          D1A P      02005010120050101        N                           
A8000001003Helmet, protective, soft, prefabricated, includes all components and accessoriesSoft protect helmet prefab  32      A                                                                                                     C                          D1E APR    02007010120070101        N                           
A8001001003Helmet, protective, hard, prefabricated, includes all components and accessoriesHard protect helmet prefab  32      A                                                                                                     C                          D1E APR    02007010120070101        N                           
A8002001003Helmet, protective, soft, custom fabricated, includes all components and        Soft protect helmet custom  45      A                                                                                                     C                          D1E APR    02007010120070101        N                           
A8002002004accessories                                                                                                                                                                                                                                                                                                          
A8003001003Helmet, protective, hard, custom fabricated, includes all components and        Hard protect helmet custom  45      A                                                                                                     C                          D1E APR    02007010120070101        N                           
A8003002004accessories                                                                                                                                                                                                                                                                                                          
A8004001003Soft interface for helmet, replacement only                                     Repl soft interface, helmet 32      A                                                                                                     C                          D1E APR    02007010120070101        N                           
A9150001003Non-prescription drugs                                                          Misc/exper non-prescript dru57      A                  2050.5                                                                             D                          O1E 9      01986010119960101        N                           
A9152001003Single vitamin/mineral/trace element, oral, per dose, not otherwise specified   Single vitamin nos          00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
A9153001003Multiple vitamins, with or without minerals and trace elements, oral, per dose, Multi-vitamin nos           00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
A9153002004not otherwise specified                                                                                                                                                                                                                                                                                              
A9155001003Artificial saliva, 30 ml                                                        Artificial saliva           57      A                                                                                                     C                          Z2  9      02008010120080101        N                           
A9180001003Pediculosis (lice infestation) treatment, topical, for administration by        Lice treatment, topical     00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
A9180002004patient/caretaker                                                                                                                                                                                                                                                                                                    
A9270001003Non-covered item or service                                                     Non-covered item or service 00      9                  2303                                                                               M                      0106Z2  9      01986010120020101        N                           
A9272001003Wound suction, disposable, includes dressing, all accessories and components,   Disp wound suct, drsg/access00      9                                          1861(n)                                                    S                          D1A 9      02012010120150101        N                           
A9272002004any type, each                                                                                                                                                                                                                                                                                                       
A9273001003Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type    Hot/cold botle/cap/col/wrap 00      9                                                                                                     M                      0137Z2  APR    02011010120190101        C                           
A9274001003External ambulatory insulin delivery system, disposable, each, includes all     Ext amb insulin delivery sys00      9                                          1861(n)                                                    S                          D1A 9      02008010120150101        N                           
A9274002004supplies and accessories                                                                                                                                                                                                                                                                                             
A9275001003Home glucose disposable monitor, includes test strips                           Disp home glucose monitor   00      9                                                                                                     M                      0131T1E 9      02006010120060101        N                           
A9276001003Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial    Disposable sensor, cgm sys  00      9                                          1861(n)                                                    S                          D1E 9      02008010120080101        N                           
A9276002004continuous glucose monitoring system, one unit = 1 day supply                                                                                                                                                                                                                                                        
A9277001003Transmitter; external, for use with interstitial continuous glucose monitoring  External transmitter, cgm   00      9                                          1861(n)                                                    S                          D1E 9      02008010120080101        N                           
A9277002004system                                                                                                                                                                                                                                                                                                               
A9278001003Receiver (monitor); external, for use with interstitial continuous glucose      External receiver, cgm sys  00      9                                          1861(n)                                                    S                          D1E 9      02008010120080101        N                           
A9278002004monitoring system                                                                                                                                                                                                                                                                                                    
A9279001003Monitoring feature/device, stand-alone or integrated, any type, includes all    Monitoring feature/devicenoc00      9                                          1861(n)                                                    S                          T2D 9      02007010120150101        N                           
A9279002004accessories, components and electronics, not otherwise classified                                                                                                                                                                                                                                                    
A9280001003Alert or alarm device, not otherwise classified                                 Alert device, noc           00      9                                          1861                                                       S                          Z2  9      02004010120040101        N                           
A9281001003Reaching/grabbing device, any type, any length, each                            Reaching/grabbing device    00      9                                          1862 SSA                                                   S                          D1E APR    02006010120060101        N                           
A9282001003Wig, any type, each                                                             Wig any type                00      9                                          1861SSA                                                    S                          Z2  9      02006010120060101        N                           
A9283001003Foot pressure off loading/supportive device, any type, each                     Foot press off load supp dev00      9                                          1862a(i)13                                                 S                          D1E P      02008010120080101        N                           
A9284001003Spirometer, non-electronic, includes all accessories                            Non-electronic spirometer   00      9                                                                                                     D                      0156Z2  APR    02009010120090101        N                           
A9285001003Inversion/eversion correction device                                            Inversion eversion cor devic00      9                                                                                                     C                          Z2  9      02017010120170101        N                           
A9286001003Hygienic item or device, disposable or non-disposable, any type, each           Any hygienic item, device   00      9                                          1834                                                       S                      0209D1A 9      02017010120170101        N                           
A9300001003Exercise equipment                                                              Exercise equipment          00      960-9              2100.1                                                                             M                          Z2  9      01993010119960101        N                           
A9500001003Technetium tc-99m sestamibi, diagnostic, per study dose                         Tc99m sestamibi             57      A                                                                                                     C                          I1E 4      01996010120100101        N                           
A9501001003Technetium tc-99m teboroxime, diagnostic, per study dose                        Technetium tc-99m teboroxime57      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9502001003Technetium tc-99m tetrofosmin, diagnostic, per study dose                       Tc99m tetrofosmin           57      A                                                                                                     C                          I1E 4      01998010120090101        N                           
A9503001003Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries   Tc99m medronate             57      A                                                                                                     C                          I1E 4      01997010120060101        N                           
A9504001003Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries    Tc99m apcitide              57      A                                                                                                     C                          I1E 4      02000010120060101        N                           
A9505001003Thallium tl-201 thallous chloride, diagnostic, per millicurie                   Tl201 thallium              57      A                                                                                                     C                          I1E 4      01996010120060101        N                           
A9507001003Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10          In111 capromab              57      A                                                                                                     C                          I1E 4      01999010120060101        N                           
A9507002004millicuries                                                                                                                                                                                                                                                                                                          
A9508001003Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie                 I131 iodobenguate, dx       51      A                                                                                                     C                          I1E 4      02001010120060101        N                           
A9509001003Iodine i-123 sodium iodide, diagnostic, per millicurie                          Iodine i-123 sod iodide mil 57      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9510001003Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries   Tc99m disofenin             51      A                                                                                                     C                          I1E 4      02001010120060101        N                           
A9512001003Technetium tc-99m pertechnetate, diagnostic, per millicurie                     Tc99m pertechnetate         57      A                                                                                                     C                          I1E 4      02003010120060101        N                           
A9513001003Lutetium lu 177, dotatate, therapeutic, 1 millicurie                            Lutetium lu 177 dotatat ther57      A153.60                                                                                               DYY20190101                I1E 6      02019010120190101        A                           
A9515001003Choline c-11, diagnostic, per study dose up to 20 millicuries                   Choline c-11                57      A                                                                                                     C                          I1E 4      02017010120190101        P                           
A9516001003Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999          Iodine i-123 sod iodide mic 57      A                                                                                                     C                          I1E 4      02003010120080101        N                           
A9516002004microcuries                                                                                                                                                                                                                                                                                                          
A9517001003Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie              I131 iodide cap, rx         57      A                                                                                                     C                          I1E 6      02003010120060101        N                           
A9520001003Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries                Tc99 tilmanocept diag 0.5mci57      A                                                                                                     C                          I1E 4      02014010120160101        N                           
A9521001003Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries Tc99m exametazime           57      A                                                                                                     C                          I1E 4      02003010120060101        N                           
A9524001003Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries             I131 serum albumin, dx      57      A                                                                                                     C                          I1E 4      02003010120060101        N                           
A9526001003Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries         Nitrogen n-13 ammonia       53      A                                                                                                     C                          I1E 4      02004010120060101        N                           
A9527001003Iodine i-125, sodium iodide solution, therapeutic, per millicurie               Iodine i-125 sodium iodide  57      A                                                                                                     CYY20080101                I1E 4      02007010120070101        N                           
A9528001003Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie               Iodine i-131 iodide cap, dx 57      A                                                                                                     C                          I1E 4      02004010120060101        N                           
A9529001003Iodine i-131 sodium iodide solution, diagnostic, per millicurie                 I131 iodide sol, dx         57      A                                                                                                     C                          I1E 4      02004010120060101        N                           
A9530001003Iodine i-131 sodium iodide solution, therapeutic, per millicurie                I131 iodide sol, rx         57      A                                                                                                     C                          I1E 6      02004010120060101        N                           
A9531001003Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)  I131 max 100uci             57      A                                                                                                     C                          I1E 4      02004010120060101        N                           
A9532001003Iodine i-125 serum albumin, diagnostic, per 5 microcuries                       I125 serum albumin, dx      57      A                                                                                                     C                          I1E 6      02004010120060101        N                           
A9536001003Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries  Tc99m depreotide            57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9537001003Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries  Tc99m mebrofenin            57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9538001003Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25           Tc99m pyrophosphate         57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9538002004millicuries                                                                                                                                                                                                                                                                                                          
A9539001003Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries   Tc99m pentetate             57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9540001003Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 Tc99m maa                   57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9540002004millicuries                                                                                                                                                                                                                                                                                                          
A9541001003Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20          Tc99m sulfur colloid        57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9541002004millicuries                                                                                                                                                                                                                                                                                                          
A9542001003Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5         In111 ibritumomab, dx       51      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9542002004millicuries                                                                                                                                                                                                                                                                                                          
A9543001003Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40    Y90 ibritumomab, rx         51      A                                                                                                     C                          I1E 6      02006010120060101        N                           
A9543002004millicuries                                                                                                                                                                                                                                                                                                          
A9544001003Iodine i-131 tositumomab, diagnostic, per study dose                            I131 tositumomab, dx        57      A                                                                                                     C                          I1E 4      0200601012017010120161231N                           
A9545001003Iodine i-131 tositumomab, therapeutic, per treatment dose                       I131 tositumomab, rx        57      A                                                                                                     C                          I1E 6      0200601012017010120161231N                           
A9546001003Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie Co57/58                     53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9547001003Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie                      In111 oxyquinoline          53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9548001003Indium in-111 pentetate, diagnostic, per 0.5 millicurie                         In111 pentetate             53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9550001003Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25       Tc99m gluceptate            53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9550002004millicurie                                                                                                                                                                                                                                                                                                           
A9551001003Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries    Tc99m succimer              53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9552001003Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries   F18 fdg                     53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9553001003Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250           Cr51 chromate               53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9553002004microcuries                                                                                                                                                                                                                                                                                                          
A9554001003Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10           I125 iothalamate, dx        53      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9554002004microcuries                                                                                                                                                                                                                                                                                                          
A9555001003Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries                Rb82 rubidium               99      9                                                                                                     C                          I1E 4      02006010120060101        N                           
A9556001003Gallium ga-67 citrate, diagnostic, per millicurie                               Ga67 gallium                57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9557001003Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries    Tc99m bicisate              57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9558001003Xenon xe-133 gas, diagnostic, per 10 millicuries                                Xe133 xenon 10mci           57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9559001003Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1          Co57 cyano                  57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9559002004microcurie                                                                                                                                                                                                                                                                                                           
A9560001003Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 Tc99m labeled rbc           57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9560002004millicuries                                                                                                                                                                                                                                                                                                          
A9561001003Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries  Tc99m oxidronate            57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9562001003Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries  Tc99m mertiatide            57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9563001003Sodium phosphate p-32, therapeutic, per millicurie                              P32 na phosphate            57      A                                                                                                     C                          I1E 6      02006010120060101        N                           
A9564001003Chromic phosphate p-32 suspension, therapeutic, per millicurie                  P32 chromic phosphate       57      A                                                                                                     C                          I1E 6      02006010120060101        N                           
A9566001003Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries Tc99m fanolesomab           57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9567001003Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75      Technetium tc-99m aerosol   57      A                                                                                                     C                          I1E 4      02006010120060101        N                           
A9567002004millicuries                                                                                                                                                                                                                                                                                                          
A9568001003Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries Technetium tc99m arcitumomab53      A                                                                                                     C                          I1E 4      02007010120070101        N                           
A9569001003Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, Technetium tc-99m auto wbc  57      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9569002004per study dose                                                                                                                                                                                                                                                                                                       
A9570001003Indium in-111 labeled autologous white blood cells, diagnostic, per study dose  Indium in-111 auto wbc      57      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9571001003Indium in-111 labeled autologous platelets, diagnostic, per study dose          Indium in-111 auto platelet 57      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9572001003Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries    Indium in-111 pentetreotide 57      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9575001003Injection, gadoterate meglumine, 0.1 ml                                         Inj gadoterate meglumi 0.1ml57      A                                                                                                     C                          I1E 4      02014010120140101        N                           
A9576001003Injection, gadoteridol, (prohance multipack), per ml                            Inj prohance multipack      51      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9577001003Injection, gadobenate dimeglumine (multihance), per ml                          Inj multihance              51      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9578001003Injection, gadobenate dimeglumine (multihance multipack), per ml                Inj multihance multipack    51      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9579001003Injection, gadolinium-based magnetic resonance contrast agent, not otherwise    Gad-base mr contrast nos,1ml51      A                                                                                                     C                          I1E 4      02008010120080101        N                           
A9579002004specified (nos), per ml                                                                                                                                                                                                                                                                                              
A9580001003Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries          Sodium fluoride f-18        57      A                                                                                                     C                          I1E 4      02009010120090101        N                           
A9581001003Injection, gadoxetate disodium, 1 ml                                            Gadoxetate disodium inj     51      A                                                                                                     C                          I2D 1P     02010010120100101        N                           
A9582001003Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries       Iodine i-123 iobenguane     51      A                                                                                                     C                          I1E 4      02010010120100101        N                           
A9583001003Injection, gadofosveset trisodium, 1 ml                                         Gadofosveset trisodium inj  51      A                                                                                                     C                          I1E 4      02010010120100101        N                           
A9584001003Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries         Iodine i-123 ioflupane      57      A                                                                                                     C                          I1E 4      02012010120120101        N                           
A9585001003Injection, gadobutrol, 0.1 ml                                                   Gadobutrol injection        57      A                                                                                                     C                          I1E 4      02012010120120101        N                           
A9586001003Florbetapir f18, diagnostic, per study dose, up to 10 millicuries               Florbetapir f18             00      9                                                                                                     DYY20181001            0189I1E 4      02013010120181001        P                           
A9587001003Gallium ga-68, dotatate, diagnostic, 0.1 millicurie                             Gallium ga-68               57      A                                                                                                     CYY20170101                I1E 4      02017010120170101        N                           
A9588001003Fluciclovine f-18, diagnostic, 1 millicurie                                     Fluciclovine f-18           57      A                                                                                                     CYY20170101                I1E 4      02017010120170101        N                           
A9589001003Instillation, hexaminolevulinate hydrochloride, 100 mg                          Insti hexaminolevulinate hcl57      A                                                                                                     C                          I1E 4      02019010120190101        A                           
A9597001003Positron emission tomography radiopharmaceutical, diagnostic, for tumor         Pet, dx, for tumor id, noc  57      A                                                                                                     C                          I1E 4      02017010120170101        N                           
A9597002004identification, not otherwise classified                                                                                                                                                                                                                                                                             
A9598001003Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor     Pet dx for non-tumor id, noc57      A                                                                                                     C                          I1E 4      02017010120170101        N                           
A9598002004identification, not otherwise classified                                                                                                                                                                                                                                                                             
A9599001003Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography  Radioph dx b amyloid pet nos57      A                                                                                                     D                      0191I1E 4      0201401012018010120171231N                           
A9599002004(pet) imaging, per study dose, not otherwise specified                                                                                                                                                                                                                                                               
A9600001003Strontium sr-89 chloride, therapeutic, per millicurie                           Sr89 strontium              57      A                                                                                                     C                          I1E 6      01998010120060101        N                           
A9604001003Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150          Sm 153 lexidronam           57      A                                                                                                     C                          I1E 6      02010010120100101        N                           
A9604002004millicuries                                                                                                                                                                                                                                                                                                          
A9606001003Radium ra-223 dichloride, therapeutic, per microcurie                           Radium ra223 dichloride ther57      A                                                                                                     C                          I1E 4      02015010120180101        N                           
A9698001003Non-radioactive contrast imaging material, not otherwise classified, per study  Non-rad contrast materialnoc51      A                  15022                                                                              D                          I1E 4      02006010120060101        N                           
A9699001003Radiopharmaceutical, therapeutic, not otherwise classified                      Radiopharm rx agent noc     57      A                                                                                                     C                          I1E 6      02003010120060101        N                           
A9700001003Supply of injectable contrast material for use in echocardiography, per study   Echocardiography contrast   57      A                  15360                                                                              D                          I1E 9      02001010120010101        N                           
A9900001003Miscellaneous dme supply, accessory, and/or service component of another hcpcs  Supply/accessory/service    46      A                                                                                                     C                          D1E 9      02000010120010101        N                           
A9900002004code                                                                                                                                                                                                                                                                                                                 
A9901001003Dme delivery, set up, and/or dispensing service component of another hcpcs code Delivery/set up/dispensing  46      A                                                                                                     C                          D1E 9      02000010120010101        N                           
A9999001003Miscellaneous dme supply or accessory, not otherwise specified                  Dme supply or accessory, nos46      A                                                                                                     C                          D1F 9      02004010120040101        N                           
B4034001003Enteral feeding supply kit; syringe fed, per day, includes but not limited to   Enter feed supkit syr by day39      A65-10             2130    4450                                                                       D                          O1C E      01986010120110101        N                           
B4034002004feeding/flushing syringe, administration set tubing, dressings, tape                                                                                                                                                                                                                                                 
B4035001003Enteral feeding supply kit; pump fed, per day, includes but not limited to      Enteral feed supp pump per d39      A65-10             2130    4450                                                                       D                          O1C E      01986010120110101        N                           
B4035002004feeding/flushing syringe, administration set tubing, dressings, tape                                                                                                                                                                                                                                                 
B4036001003Enteral feeding supply kit; gravity fed, per day, includes but not limited to   Enteral feed sup kit grav by39      A65-10             2130    4450                                                                       D                          O1C E      01986010120110101        N                           
B4036002004feeding/flushing syringe, administration set tubing, dressings, tape                                                                                                                                                                                                                                                 
B4081001003Nasogastric tubing with stylet                                                  Enteral ng tubing w/ stylet 39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4082001003Nasogastric tubing without stylet                                               Enteral ng tubing w/o stylet39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4083001003Stomach tube - levine type                                                      Enteral stomach tube levine 39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4087001003Gastrostomy/jejunostomy tube, standard, any material, any type, each            Gastro/jejuno tube, std     39      A                                                                                                     C                          O1C E      02008010120080101        N                           
B4088001003Gastrostomy/jejunostomy tube, low-profile, any material, any type, each         Gastro/jejuno tube, low-pro 39      A                                                                                                     C                          O1C E      02008010120160101        N                           
B4100001003Food thickener, administered orally, per ounce                                  Food thickener oral         00      960-9                                                                                                 M                          Z2  E      02003010120050101        N                           
B4102001003Enteral formula, for adults, used to replace fluids and electrolytes (e.g.,     Ef adult fluids and electro 39      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4102002004clear liquids), 500 ml = 1 unit                                                                                                                                                                                                                                                                                      
B4103001003Enteral formula, for pediatrics, used to replace fluids and electrolytes (e.g., Ef ped fluid and electrolyte46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4103002004clear liquids), 500 ml = 1 unit                                                                                                                                                                                                                                                                                      
B4104001003Additive for enteral formula (e.g., fiber)                                      Additive for enteral formula00      965-10                                                                                                D                          O1C E      02005010120050101        N                           
B4105001003In-line cartridge containing digestive enzyme(s) for enteral feeding, each      Enzyme cartridge enteral nut00      9                                                                            Q9994                    D                      0217O1C E      02019010120190101        A                           
B4149001003Enteral formula, manufactured blenderized natural foods with intact nutrients,  Ef blenderized foods        39      A65-10             2130    4450                                                                       D                          O1C E      02005010120060101        N                           
B4149002004includes proteins, fats, carbohydrates, vitamins and minerals, may include                                                                                                                                                                                                                                           
B4149003004fiber, administered through an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                           
B4150001003Enteral formula, nutritionally complete with intact nutrients, includes         Ef complet w/intact nutrient39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N                           
B4150002004proteins, fats, carbohydrates, vitamins and minerals, may include fiber,                                                                                                                                                                                                                                             
B4150003004administered through an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                                  
B4152001003Enteral formula, nutritionally complete, calorically dense (equal to or greater Ef calorie dense>/=1.5kcal  39      A65-10             2130    4450                                                                       D                          O1C E      01984010120050101        N                           
B4152002004than 1.5 kcal/ml) with intact nutrients, includes proteins, fats,                                                                                                                                                                                                                                                    
B4152003004carbohydrates, vitamins and minerals, may include fiber, administered through                                                                                                                                                                                                                                        
B4152004004an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                                                       
B4153001003Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and   Ef hydrolyzed/amino acids   39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N                           
B4153002004peptide chain), includes fats, carbohydrates, vitamins and minerals, may                                                                                                                                                                                                                                             
B4153003004include fiber, administered through an enteral feeding tube, 100 calories = 1                                                                                                                                                                                                                                        
B4153004004unit                                                                                                                                                                                                                                                                                                                 
B4154001003Enteral formula, nutritionally complete, for special metabolic needs, excludes  Ef spec metabolic noninherit39      A65-10             2130    4450                                                                       D                          O1C E      01984010120050101        N                           
B4154002004inherited disease of metabolism, includes altered composition of proteins,                                                                                                                                                                                                                                           
B4154003004fats, carbohydrates, vitamins and/or minerals, may include fiber, administered                                                                                                                                                                                                                                       
B4154004004through an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                                               
B4155001003Enteral formula, nutritionally incomplete/modular nutrients, includes specific  Ef incomplete/modular       39      A65-10             2130    4450                                                                       D                          O1C E      01986010120050101        N                           
B4155002004nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g.,                                                                                                                                                                                                                                       
B4155003004glutamine, arginine), fat (e.g., medium chain triglycerides) or combination,                                                                                                                                                                                                                                         
B4155004004administered through an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                                  
B4157001003Enteral formula, nutritionally complete, for special metabolic needs for        Ef special metabolic inherit39      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4157002004inherited disease of metabolism, includes proteins, fats, carbohydrates,                                                                                                                                                                                                                                             
B4157003004vitamins and minerals, may include fiber, administered through an enteral                                                                                                                                                                                                                                            
B4157004004feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                                                                  
B4158001003Enteral formula, for pediatrics, nutritionally complete with intact nutrients,  Ef ped complete intact nut  46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4158002004includes proteins, fats, carbohydrates, vitamins and minerals, may include                                                                                                                                                                                                                                           
B4158003004fiber and/or iron, administered through an enteral feeding tube, 100 calories =                                                                                                                                                                                                                                      
B41580040041 unit                                                                                                                                                                                                                                                                                                               
B4159001003Enteral formula, for pediatrics, nutritionally complete soy based with intact   Ef ped complete soy based   46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4159002004nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may                                                                                                                                                                                                                                        
B4159003004include fiber and/or iron, administered through an enteral feeding tube, 100                                                                                                                                                                                                                                         
B4159004004calories = 1 unit                                                                                                                                                                                                                                                                                                    
B4160001003Enteral formula, for pediatrics, nutritionally complete calorically dense       Ef ped caloric dense>/=0.7kc46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4160002004(equal to or greater than 0.7 kcal/ml) with intact nutrients, includes                                                                                                                                                                                                                                               
B4160003004proteins, fats, carbohydrates, vitamins and minerals, may include fiber,                                                                                                                                                                                                                                             
B4160004004administered through an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                                  
B4161001003Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain       Ef ped hydrolyzed/amino acid46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4161002004proteins, includes fats, carbohydrates, vitamins and minerals, may include                                                                                                                                                                                                                                           
B4161003004fiber, administered through an enteral feeding tube, 100 calories = 1 unit                                                                                                                                                                                                                                           
B4162001003Enteral formula, for pediatrics, special metabolic needs for inherited disease  Ef ped specmetabolic inherit46      A65-10                                                                                                D                          O1C E      02005010120050101        N                           
B4162002004of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals,                                                                                                                                                                                                                                        
B4162003004may include fiber, administered through an enteral feeding tube, 100 calories =                                                                                                                                                                                                                                      
B41620040041 unit                                                                                                                                                                                                                                                                                                               
B4164001003Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml =  Parenteral 50% dextrose solu39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B41640020041 unit) - home mix                                                                                                                                                                                                                                                                                                   
B4168001003Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix   Parenteral sol amino acid 3.39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4172001003Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - Parenteral sol amino acid 5.39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4172002004home mix                                                                                                                                                                                                                                                                                                             
B4176001003Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - Parenteral sol amino acid 7-39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4176002004home mix                                                                                                                                                                                                                                                                                                             
B4178001003Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit)  Parenteral sol amino acid > 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4178002004- home mix                                                                                                                                                                                                                                                                                                           
B4180001003Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500  Parenteral sol carb > 50%   39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4180002004ml = 1 unit) - home mix                                                                                                                                                                                                                                                                                              
B4185001003Parenteral nutrition solution, per 10 grams lipids                              Parenteral sol 10 gm lipids 39      A                                                                                                     D                      0126O1C E      02006010120060101        N                           
B4189001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol amino acid & 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4189002004electrolytes, trace elements, and vitamins, including preparation, any                                                                                                                                                                                                                                               
B4189003004strength, 10 to 51 grams of protein - premix                                                                                                                                                                                                                                                                         
B4193001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol 52-73 gm prot39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4193002004electrolytes, trace elements, and vitamins, including preparation, any                                                                                                                                                                                                                                               
B4193003004strength, 52 to 73 grams of protein - premix                                                                                                                                                                                                                                                                         
B4197001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol 74-100 gm pro39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4197002004electrolytes, trace elements and vitamins, including preparation, any strength,                                                                                                                                                                                                                                      
B419700300474 to 100 grams of protein - premix                                                                                                                                                                                                                                                                                  
B4199001003Parenteral nutrition solution; compounded amino acid and carbohydrates with     Parenteral sol > 100gm prote39      A65-10             2130    4450                                                                       D                          O1C E      01988010120020101        N                           
B4199002004electrolytes, trace elements and vitamins, including preparation, any strength,                                                                                                                                                                                                                                      
B4199003004over 100 grams of protein - premix                                                                                                                                                                                                                                                                                   
B4216001003Parenteral nutrition; additives (vitamins, trace elements, heparin,             Parenteral nutrition additiv39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4216002004electrolytes), home mix, per day                                                                                                                                                                                                                                                                                     
B4220001003Parenteral nutrition supply kit; premix, per day                                Parenteral supply kit premix39      A65-10             2130    4450                                                                       D                          O1C E      01984010120020101        N                           
B4222001003Parenteral nutrition supply kit; home mix, per day                              Parenteral supply kit homemi39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B4224001003Parenteral nutrition administration kit, per day                                Parenteral administration ki39      A65-10             2130    4450                                                                       D                          O1C E      01986010120020101        N                           
B5000001003Parenteral nutrition solution compounded amino acid and carbohydrates with      Parenteral sol renal-amirosy39      A65-10             2130    4450                                                                       D                          O1C E      01988010120160101        N                           
B5000002004electrolytes, trace elements, and vitamins, including preparation, any                                                                                                                                                                                                                                               
B5000003004strength, renal-aminosyn-rf, nephramine, renamine-premix                                                                                                                                                                                                                                                             
B5100001003Parenteral nutrition solution compounded amino acid and carbohydrates with      Parenteral solution hepatic 39      A65-10             2130    4450                                                                       D                          O1C E      01988010120160101        N                           
B5100002004electrolytes, trace elements, and vitamins, including preparation, any                                                                                                                                                                                                                                               
B5100003004strength, hepatic, hepatamine-premix                                                                                                                                                                                                                                                                                 
B5200001003Parenteral nutrition solution compounded amino acid and carbohydrates with      Parenteral sol hepatic fream39      A65-10             2130    4450                                                                       D                          O1C E      01988010120160101        N                           
B5200002004electrolytes, trace elements, and vitamins, including preparation, any                                                                                                                                                                                                                                               
B5200003004strength, stress-branch chain amino acids-freamine-hbc-premix                                                                                                                                                                                                                                                        
B9000001003Enteral nutrition infusion pump - without alarm                                 Enter infusion pump w/o alrm39      A65-10             2130    4450                                                                       D                          O1C APR    0198801012017010120161231N                           
B9002001003Enteral nutrition infusion pump, any type                                       Enter nutr inf pump any type39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120170101        N                           
B9004001003Parenteral nutrition infusion pump, portable                                    Parenteral infus pump portab39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N                           
B9006001003Parenteral nutrition infusion pump, stationary                                  Parenteral infus pump statio39      A65-10             2130    4450                                                                       D                          O1C APR    01988010120020101        N                           
B9998001003Noc for enteral supplies                                                        Enteral supp not otherwise c57      A65-10             2130    4450                                                                       D                          O1C E      01985010119960101        N                           
B9999001003Noc for parenteral supplies                                                     Parenteral supp not othrws c57      A65-10             2130    4450                                                                       D                          O1C E      01985010119960101        N                           
C1300001003Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval     Hyperbaric oxygen           53      A                                          1833(T)                                                    D                      0093P5E 9      0200008012015010120141231N                           
C1713001003Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)     Anchor/screw bn/bn,tis/bn   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1714001003Catheter, transluminal atherectomy, directional                                 Cath, trans atherectomy, dir53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1715001003Brachytherapy needle                                                            Brachytherapy needle        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1716001003Brachytherapy source, non-stranded, gold-198, per source                        Brachytx, non-str, gold-198 53      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N                           
C1717001003Brachytherapy source, non-stranded, high dose rate iridium-192, per source      Brachytx, non-str,hdr ir-19253      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N                           
C1719001003Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source  Brachytx, ns, non-hdrir-192 53      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N                           
C1721001003Cardioverter-defibrillator, dual chamber (implantable)                          Aicd, dual chamber          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1722001003Cardioverter-defibrillator, single chamber (implantable)                        Aicd, single chamber        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1724001003Catheter, transluminal atherectomy, rotational                                  Cath, trans atherec,rotation53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1725001003Catheter, transluminal angioplasty, non-laser (may include guidance,            Cath, translumin non-laser  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1725002004infusion/perfusion capability)                                                                                                                                                                                                                                                                                       
C1726001003Catheter, balloon dilatation, non-vascular                                      Cath, bal dil, non-vascular 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1727001003Catheter, balloon tissue dissector, non-vascular (insertable)                   Cath, bal tis dis, non-vas  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1728001003Catheter, brachytherapy seed administration                                     Cath, brachytx seed adm     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1729001003Catheter, drainage                                                              Cath, drainage              53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1730001003Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer     Cath, ep, 19 or few elect   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1730002004electrodes)                                                                                                                                                                                                                                                                                                          
C1731001003Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more      Cath, ep, 20 or more elec   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1731002004electrodes)                                                                                                                                                                                                                                                                                                          
C1732001003Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping          Cath, ep, diag/abl, 3d/vect 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1733001003Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector       Cath, ep, othr than cool-tip53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1733002004mapping, other than cool-tip                                                                                                                                                                                                                                                                                         
C1749001003Endoscope, retrograde imaging/illumination colonoscope device (implantable)     Endo, colon, retro imaging  53      A                                          1833(t)                                                    D                          D1A 9S     02010100120101001        N                           
C1750001003Catheter, hemodialysis/peritoneal, long-term                                    Cath, hemodialysis,long-term53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N                           
C1751001003Catheter, infusion, inserted peripherally, centrally or midline (other than     Cath, inf, per/cent/midline 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1751002004hemodialysis)                                                                                                                                                                                                                                                                                                        
C1752001003Catheter, hemodialysis/peritoneal, short-term                                   Cath,hemodialysis,short-term53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N                           
C1753001003Catheter, intravascular ultrasound                                              Cath, intravas ultrasound   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1754001003Catheter, intradiscal                                                           Catheter, intradiscal       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1755001003Catheter, intraspinal                                                           Catheter, intraspinal       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1756001003Catheter, pacing, transesophageal                                               Cath, pacing, transesoph    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1757001003Catheter, thrombectomy/embolectomy                                              Cath, thrombectomy/embolect 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1758001003Catheter, ureteral                                                              Catheter, ureteral          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1759001003Catheter, intracardiac echocardiography                                         Cath, intra echocardiography53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1760001003Closure device, vascular (implantable/insertable)                               Closure dev, vasc           53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1762001003Connective tissue, human (includes fascia lata)                                 Conn tiss, human(inc fascia)53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1763001003Connective tissue, non-human (includes synthetic)                               Conn tiss, non-human        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1764001003Event recorder, cardiac (implantable)                                           Event recorder, cardiac     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1765001003Adhesion barrier                                                                Adhesion barrier            53      A                                          1833(T)                                                    D                          D1A 9S     02001070120010701        N                           
C1766001003Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other Intro/sheath,strble,non-peel53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1766002004than peel-away                                                                                                                                                                                                                                                                                                       
C1767001003Generator, neurostimulator (implantable), non-rechargeable                      Generator, neuro non-recharg53      A                                          1833(T)                                                    D                          D1A 9S     02001040120060101        N                           
C1768001003Graft, vascular                                                                 Graft, vascular             53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1769001003Guide wire                                                                      Guide wire                  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1770001003Imaging coil, magnetic resonance (insertable)                                   Imaging coil, mr, insertable53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1771001003Repair device, urinary, incontinence, with sling graft                          Rep dev, urinary, w/sling   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1772001003Infusion pump, programmable (implantable)                                       Infusion pump, programmable 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1773001003Retrieval device, insertable (used to retrieve fractured medical devices)       Ret dev, insertable         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1776001003Joint device (implantable)                                                      Joint device (implantable)  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1777001003Lead, cardioverter-defibrillator, endocardial single coil (implantable)         Lead, aicd, endo single coil53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1778001003Lead, neurostimulator (implantable)                                             Lead, neurostimulator       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1779001003Lead, pacemaker, transvenous vdd single pass                                    Lead, pmkr, transvenous vdd 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1780001003Lens, intraocular (new technology)                                              Lens, intraocular (new tech)53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1781001003Mesh (implantable)                                                              Mesh (implantable)          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1782001003Morcellator                                                                     Morcellator                 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1783001003Ocular implant, aqueous drainage assist device                                  Ocular imp, aqueous drain de53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N                           
C1784001003Ocular device, intraoperative, detached retina                                  Ocular dev, intraop, det ret53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1785001003Pacemaker, dual chamber, rate-responsive (implantable)                          Pmkr, dual, rate-resp       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1786001003Pacemaker, single chamber, rate-responsive (implantable)                        Pmkr, single, rate-resp     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1787001003Patient programmer, neurostimulator                                             Patient progr, neurostim    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1788001003Port, indwelling (implantable)                                                  Port, indwelling, imp       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1789001003Prosthesis, breast (implantable)                                                Prosthesis, breast, imp     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1813001003Prosthesis, penile, inflatable                                                  Prosthesis, penile, inflatab53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1814001003Retinal tamponade device, silicone oil                                          Retinal tamp, silicone oil  53      A                                          1833t                                                      D                          D1A 9S     02003040120030401        N                           
C1815001003Prosthesis, urinary sphincter (implantable)                                     Pros, urinary sph, imp      53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1816001003Receiver and/or transmitter, neurostimulator (implantable)                      Receiver/transmitter, neuro 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1817001003Septal defect implant system, intracardiac                                      Septal defect imp sys       53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1818001003Integrated keratoprosthesis                                                     Integrated keratoprosthesis 53      A                                          1833T                                                      D                          D1A 9S     02003070120030701        N                           
C1819001003Surgical tissue localization and excision device (implantable)                  Tissue localization-excision53      A                                          1833T                                                      D                      0093D1A 9S     02004010120040101        N                           
C1820001003Generator, neurostimulator (implantable), with rechargeable battery and         Generator neuro rechg bat sy53      A                                          1833(T)                                                    D                          D1A 9F     02006010120060101        N                           
C1820002004charging system                                                                                                                                                                                                                                                                                                      
C1821001003Interspinous process distraction device (implantable)                           Interspinous implant        53      A                                          1833(T)                                                    D                          D1A 9      02007010120070101        N                           
C1822001003Generator, neurostimulator (implantable), high frequency, with rechargeable     Gen, neuro, hf, rechg bat   53      A                                          1833(T)                                                    D                          D1A 9F     02016010120180101        N                           
C1822002004battery and charging system                                                                                                                                                                                                                                                                                          
C1823001003Generator, neurostimulator (implantable), non-rechargeable, with transvenous    Gen, neuro, trans sen/stim  53      A                                          1833(t)                                                    DYY20190101                D1A 9F     02019010120190101        A                           
C1823002004sensing and stimulation leads                                                                                                                                                                                                                                                                                        
C1830001003Powered bone marrow biopsy needle                                               Power bone marrow bx needle 53      A                                          1833(t)                                                    D                          D1A 9S     02011100120140101        N                           
C1840001003Lens, intraocular (telescopic)                                                  Telescopic intraocular lens 53      A                                          1833(t)                                                    D                          D1A 9S     02011100120140101        N                           
C1841001003Retinal prosthesis, includes all internal and external components               Retinal prosth int/ext comp 53      A                                          1833(t)                                                    DYY20131001                D1E 9F     02013100120131001        N                           
C1842001003Retinal prosthesis, includes all internal and external components; add-on to    Retinal prosth, add-on      53      A                                          1833(t)                                                    DYY20170101                D1E 9F     02017010120170101        N                           
C1842002004c1841                                                                                                                                                                                                                                                                                                                
C1874001003Stent, coated/covered, with delivery system                                     Stent, coated/cov w/del sys 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1875001003Stent, coated/covered, without delivery system                                  Stent, coated/cov w/o del sy53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1876001003Stent, non-coated/non-covered, with delivery system                             Stent, non-coa/non-cov w/del53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1877001003Stent, non-coated/non-covered, without delivery system                          Stent, non-coat/cov w/o del 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1878001003Material for vocal cord medialization, synthetic (implantable)                  Matrl for vocal cord        53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1880001003Vena cava filter                                                                Vena cava filter            53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1881001003Dialysis access system (implantable)                                            Dialysis access system      53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1882001003Cardioverter-defibrillator, other than single or dual chamber (implantable)     Aicd, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1883001003Adapter/extension, pacing lead or neurostimulator lead (implantable)            Adapt/ext, pacing/neuro lead53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N                           
C1884001003Embolization protective system                                                  Embolization protect syst   53      A                                          1833T                                                      D                          D1A 9S     02003010120030101        N                           
C1885001003Catheter, transluminal angioplasty, laser                                       Cath, translumin angio laser53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1886001003Catheter, extravascular tissue ablation, any modality (insertable)              Catheter, ablation          53      A                                          1833(t)                                                    D                          D1A 9S     02012010120140101        N                           
C1887001003Catheter, guiding (may include infusion/perfusion capability)                   Catheter, guiding           53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1888001003Catheter, ablation, non-cardiac, endovascular (implantable)                     Endovas non-cardiac abl cath53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N                           
C1889001003Implantable/insertable device, not otherwise classified                         Implant/insert device, noc  53      A                                          1833(T)                                                    D                          D1A 9F     02017010120190101        C                           
C1891001003Infusion pump, non-programmable, permanent (implantable)                        Infusion pump,non-prog, perm53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1892001003Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve,     Intro/sheath,fixed,peel-away53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1892002004peel-away                                                                                                                                                                                                                                                                                                            
C1893001003Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve,     Intro/sheath, fixed,non-peel53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1893002004other than peel-away                                                                                                                                                                                                                                                                                                 
C1894001003Introducer/sheath, other than guiding, other than intracardiac                  Intro/sheath, non-laser     53      A                                          1833(T)                                                    D                          D1A 9S     02001040120020701        N                           
C1894002004electrophysiological, non-laser                                                                                                                                                                                                                                                                                      
C1895001003Lead, cardioverter-defibrillator, endocardial dual coil (implantable)           Lead, aicd, endo dual coil  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1896001003Lead, cardioverter-defibrillator, other than endocardial single or dual coil    Lead, aicd, non sing/dual   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1896002004(implantable)                                                                                                                                                                                                                                                                                                        
C1897001003Lead, neurostimulator test kit (implantable)                                    Lead, neurostim test kit    53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1898001003Lead, pacemaker, other than transvenous vdd single pass                         Lead, pmkr, other than trans53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1899001003Lead, pacemaker/cardioverter-defibrillator combination (implantable)            Lead, pmkr/aicd combination 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C1900001003Lead, left ventricular coronary venous system                                   Lead, coronary venous       53      A                                          1833(T)                                                    D                          D1A 9S     02002070120020701        N                           
C2613001003Lung biopsy plug with delivery system                                           Lung bx plug w/del sys      53      A                                          1833(t)                                                    D                          D1A 9F     02015070120180101        N                           
C2614001003Probe, percutaneous lumbar discectomy                                           Probe, perc lumb disc       53      A                                          1833(T)                                                    D                      0093D1A 9S     02003010120030101        N                           
C2615001003Sealant, pulmonary, liquid                                                      Sealant, pulmonary, liquid  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2616001003Brachytherapy source, non-stranded, yttrium-90, per source                      Brachytx, non-str,yttrium-9053      A                                          1833(T)                                                    DYY20080101                I4B 6      02001040120010401        N                           
C2617001003Stent, non-coronary, temporary, without delivery system                         Stent, non-cor, tem w/o del 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2618001003Probe/needle, cryoablation                                                      Probe/needle, cryo          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120140101        N                           
C2619001003Pacemaker, dual chamber, non rate-responsive (implantable)                      Pmkr, dual, non rate-resp   53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2620001003Pacemaker, single chamber, non rate-responsive (implantable)                    Pmkr, single, non rate-resp 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120010401        N                           
C2621001003Pacemaker, other than single or dual chamber (implantable)                      Pmkr, other than sing/dual  53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2622001003Prosthesis, penile, non-inflatable                                              Prosthesis, penile, non-inf 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2623001003Catheter, transluminal angioplasty, drug-coated, non-laser                      Cath, translumin, drug-coat 53      A                                          1833(t)                                                    D                          D1A 9F     02015040120180101        N                           
C2624001003Implantable wireless pulmonary artery pressure sensor with delivery catheter,   Wireless pressure sensor    53      A                                          1833(t)                                                    D                          D1A 9F     02015010120180101        N                           
C2624002004including all system components                                                                                                                                                                                                                                                                                      
C2625001003Stent, non-coronary, temporary, with delivery system                            Stent, non-cor, tem w/del sy53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2626001003Infusion pump, non-programmable, temporary (implantable)                        Infusion pump, non-prog,temp53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2627001003Catheter, suprapubic/cystoscopic                                                Cath, suprapubic/cystoscopic53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2628001003Catheter, occlusion                                                             Catheter, occlusion         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2629001003Introducer/sheath, other than guiding, other than intracardiac                  Intro/sheath, laser         53      A                                          1833(T)                                                    D                          D1A 9S     02001040120130101        N                           
C2629002004electrophysiological, laser                                                                                                                                                                                                                                                                                          
C2630001003Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector       Cath, ep, cool-tip          53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2630002004mapping, cool-tip                                                                                                                                                                                                                                                                                                    
C2631001003Repair device, urinary, incontinence, without sling graft                       Rep dev, urinary, w/o sling 53      A                                          1833(T)                                                    D                          D1A 9S     02001040120040101        N                           
C2634001003Brachytherapy source, non-stranded, high activity, iodine-125, greater than     Brachytx, non-str, ha, i-12553      A                                          1833(T)                                                    DYY20080101                I4B 9      02005010120070701        N                           
C26340020041.01 mci (nist), per source                                                                                                                                                                                                                                                                                          
C2635001003Brachytherapy source, non-stranded, high activity, palladium-103, greater than  Brachytx, non-str, ha, p-10353      A                                          1833(T)                                                    DYY20080101                I4B 9      02005010120070701        N                           
C26350020042.2 mci (nist), per source                                                                                                                                                                                                                                                                                           
C2636001003Brachytherapy linear source, non-stranded, palladium-103, per 1 mm              Brachy linear, non-str,p-10353      A                                          1833(T)                                                    DYY20080101                I4B 9      02005010120070701        N                           
C2637001003Brachytherapy source, non-stranded, ytterbium-169, per source                   Brachy,non-str,ytterbium-16953      A                                          1833(T)                                                    D                          I4B 4      02005100120070701        N                           
C2638001003Brachytherapy source, stranded, iodine-125, per source                          Brachytx, stranded, i-125   53      A                                          1833(t)(2)                                                 DYY20080101                I4B 6      02007070120070701        N                           
C2639001003Brachytherapy source, non-stranded, iodine-125, per source                      Brachytx, non-stranded,i-12553      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C2640001003Brachytherapy source, stranded, palladium-103, per source                       Brachytx, stranded, p-103   53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C2641001003Brachytherapy source, non-stranded, palladium-103, per source                   Brachytx, non-stranded,p-10353      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C2642001003Brachytherapy source, stranded, cesium-131, per source                          Brachytx, stranded, c-131   53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C2643001003Brachytherapy source, non-stranded, cesium-131, per source                      Brachytx, non-stranded,c-13153      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C2644001003Brachytherapy source, cesium-131 chloride solution, per millicurie              Brachytx cesium-131 chloride53      A                                          1833(t)                                                    D                          I4B 6F     02014070120190101        P                           
C2645001003Brachytherapy planar source, palladium-103, per square millimeter               Brachytx planar, p-103      53      A                                          1833(T)                                                    DYY20160101                I4B 9      02016010120160101        N                           
C2698001003Brachytherapy source, stranded, not otherwise specified, per source             Brachytx, stranded, nos     53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C2699001003Brachytherapy source, non-stranded, not otherwise specified, per source         Brachytx, non-stranded, nos 53      A                                          1833(t)(2)                                                 DYY20080101                I4B 4      02007070120070701        N                           
C5271001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53      A                                          1833(t)                                                    DYY20140101                P5A 2F     02014010120140101        N                           
C5271002004surface area up to 100 sq cm; first 25 sq cm or less wound surface area                                                                                                                                                                                                                                              
C5272001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53      A                                          1833(t)                                                    D                          P5A 2F     02014010120140101        N                           
C5272002004surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or                                                                                                                                                                                                                                        
C5272003004part thereof (list separately in addition to code for primary procedure)                                                                                                                                                                                                                                             
C5273001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53      A                                          1833(t)                                                    DYY20140101                P5A 2F     02014010120140101        N                           
C5273002004surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface                                                                                                                                                                                                                                       
C5273003004area, or 1% of body area of infants and children                                                                                                                                                                                                                                                                     
C5274001003Application of low cost skin substitute graft to trunk, arms, legs, total wound Low cost skin substitute app53      A                                          1833(t)                                                    D                          P5A 2F     02014010120140101        N                           
C5274002004surface area greater than or equal to 100 sq cm; each additional 100 sq cm                                                                                                                                                                                                                                           
C5274003004wound surface area, or part thereof, or each additional 1% of body area of                                                                                                                                                                                                                                           
C5274004004infants and children, or part thereof (list separately in addition to code for                                                                                                                                                                                                                                       
C5274005004primary procedure)                                                                                                                                                                                                                                                                                                   
C5275001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth,   Low cost skin substitute app53      A                                          1833(t)                                                    DYY20140101                P5A 2F     02014010120140101        N                           
C5275002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound                                                                                                                                                                                                                                      
C5275003004surface area up to 100 sq cm; first 25 sq cm or less wound surface area                                                                                                                                                                                                                                              
C5276001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth,   Low cost skin substitute app53      A                                          1833(t)                                                    D                          P5A 2F     02014010120140101        N                           
C5276002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound                                                                                                                                                                                                                                      
C5276003004surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or                                                                                                                                                                                                                                        
C5276004004part thereof (list separately in addition to code for primary procedure)                                                                                                                                                                                                                                             
C5277001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth,   Low cost skin substitute app53      A                                          1833(t)                                                    DYY20140101                P5A 2F     02014010120140101        N                           
C5277002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound                                                                                                                                                                                                                                      
C5277003004surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface                                                                                                                                                                                                                                       
C5277004004area, or 1% of body area of infants and children                                                                                                                                                                                                                                                                     
C5278001003Application of low cost skin substitute graft to face, scalp, eyelids, mouth,   Low cost skin substitute app53      A                                          1833(t)                                                    D                          P5A 2F     02014010120140101        N                           
C5278002004neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound                                                                                                                                                                                                                                      
C5278003004surface area greater than or equal to 100 sq cm; each additional 100 sq cm                                                                                                                                                                                                                                           
C5278004004wound surface area, or part thereof, or each additional 1% of body area of                                                                                                                                                                                                                                           
C5278005004infants and children, or part thereof (list separately in addition to code for                                                                                                                                                                                                                                       
C5278006004primary procedure)                                                                                                                                                                                                                                                                                                   
C8900001003Magnetic resonance angiography with contrast, abdomen                           Mra w/cont, abd             53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8901001003Magnetic resonance angiography without contrast, abdomen                        Mra w/o cont, abd           53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8902001003Magnetic resonance angiography without contrast followed by with contrast,      Mra w/o fol w/cont, abd     53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8902002004abdomen                                                                                                                                                                                                                                                                                                              
C8903001003Magnetic resonance imaging with contrast, breast; unilateral                    Mri w/cont, breast,  uni    53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8904001003Magnetic resonance imaging without contrast, breast; unilateral                 Mri w/o cont, breast, uni   53      A                                          1833(t)(2)                        77046                    D                          I2D 4      0200110012019010120181231D                           
C8905001003Magnetic resonance imaging without contrast followed by with contrast, breast;  Mri w/o fol w/cont, brst, un53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8905002004unilateral                                                                                                                                                                                                                                                                                                           
C8906001003Magnetic resonance imaging with contrast, breast; bilateral                     Mri w/cont, breast,  bi     53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8907001003Magnetic resonance imaging without contrast, breast; bilateral                  Mri w/o cont, breast, bi    53      A                                          1833(t)(2)                        77047                    D                          I2D 4      0200110012019010120181231D                           
C8908001003Magnetic resonance imaging without contrast followed by with contrast, breast;  Mri w/o fol w/cont, breast, 53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8908002004bilateral                                                                                                                                                                                                                                                                                                            
C8909001003Magnetic resonance angiography with contrast, chest (excluding myocardium)      Mra w/cont, chest           53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8910001003Magnetic resonance angiography without contrast, chest (excluding myocardium)   Mra w/o cont, chest         53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8911001003Magnetic resonance angiography without contrast followed by with contrast,      Mra w/o fol w/cont, chest   53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8911002004chest (excluding myocardium)                                                                                                                                                                                                                                                                                         
C8912001003Magnetic resonance angiography with contrast, lower extremity                   Mra w/cont, lwr ext         53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8913001003Magnetic resonance angiography without contrast, lower extremity                Mra w/o cont, lwr ext       53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8914001003Magnetic resonance angiography without contrast followed by with contrast,      Mra w/o fol w/cont, lwr ext 53      A                                          1833(t)(2)                                                 DYY20080101                I2D 4      02001100120011001        N                           
C8914002004lower extremity                                                                                                                                                                                                                                                                                                      
C8918001003Magnetic resonance angiography with contrast, pelvis                            Mra w/cont, pelvis          53      A                                          430 BIPA                                                   DYY20080101                I2D 4      02003070120030701        N                           
C8919001003Magnetic resonance angiography without contrast, pelvis                         Mra w/o cont, pelvis        53      A                                          430 BIPA                                                   DYY20080101                I2D 4      02003070120030701        N                           
C8920001003Magnetic resonance angiography without contrast followed by with contrast,      Mra w/o fol w/cont, pelvis  53      A                                          430 BIPA                                                   DYY20080101                I2D 4      02003070120030701        N                           
C8920002004pelvis                                                                                                                                                                                                                                                                                                               
C8921001003Transthoracic echocardiography with contrast, or without contrast followed by   Tte w or w/o fol w/cont, com53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N                           
C8921002004with contrast, for congenital cardiac anomalies; complete                                                                                                                                                                                                                                                            
C8922001003Transthoracic echocardiography with contrast, or without contrast followed by   Tte w or w/o fol w/cont, f/u53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N                           
C8922002004with contrast, for congenital cardiac anomalies; follow-up or limited study                                                                                                                                                                                                                                          
C8923001003Transthoracic echocardiography with contrast, or without contrast followed by   2d tte w or w/o fol w/con,co53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N                           
C8923002004with contrast, real-time with image documentation (2d), includes m-mode                                                                                                                                                                                                                                              
C8923003004recording, when performed, complete, without spectral or color doppler                                                                                                                                                                                                                                               
C8923004004echocardiography                                                                                                                                                                                                                                                                                                     
C8924001003Transthoracic echocardiography with contrast, or without contrast followed by   2d tte w or w/o fol w/con,fu53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N                           
C8924002004with contrast, real-time with image documentation (2d), includes m-mode                                                                                                                                                                                                                                              
C8924003004recording, when performed, follow-up or limited study                                                                                                                                                                                                                                                                
C8925001003Transesophageal echocardiography (tee) with contrast, or without contrast       2d tee w or w/o fol w/con,in53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N                           
C8925002004followed by with contrast, real time with image documentation (2d) (with or                                                                                                                                                                                                                                          
C8925003004without m-mode recording); including probe placement, image acquisition,                                                                                                                                                                                                                                             
C8925004004interpretation and report                                                                                                                                                                                                                                                                                            
C8926001003Transesophageal echocardiography (tee) with contrast, or without contrast       Tee w or w/o fol w/cont,cong53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N                           
C8926002004followed by with contrast, for congenital cardiac anomalies; including probe                                                                                                                                                                                                                                         
C8926003004placement, image acquisition, interpretation and report                                                                                                                                                                                                                                                              
C8927001003Transesophageal echocardiography (tee) with contrast, or without contrast       Tee w or w/o fol w/cont, mon53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120080101        N                           
C8927002004followed by with contrast, for monitoring purposes, including probe placement,                                                                                                                                                                                                                                       
C8927003004real time 2-dimensional image acquisition and interpretation leading to ongoing                                                                                                                                                                                                                                      
C8927004004(continuous) assessment of (dynamically changing) cardiac pumping function and                                                                                                                                                                                                                                       
C8927005004to therapeutic measures on an immediate time basis                                                                                                                                                                                                                                                                   
C8928001003Transthoracic echocardiography with contrast, or without contrast followed by   Tte w or w/o fol w/con,stres53      A                                          1833(t)(2)                                                 D                          I3C 4      02008010120090101        N                           
C8928002004with contrast, real-time with image documentation (2d), includes m-mode                                                                                                                                                                                                                                              
C8928003004recording, when performed, during rest and cardiovascular stress test using                                                                                                                                                                                                                                          
C8928004004treadmill, bicycle exercise and/or pharmacologically induced stress, with                                                                                                                                                                                                                                            
C8928005004interpretation and report                                                                                                                                                                                                                                                                                            
C8929001003Transthoracic echocardiography with contrast, or without contrast followed by   Tte w or wo fol wcon,doppler53      A                                          1833(t)(2)                                                 D                          I3C 4      02009010120090101        N                           
C8929002004with contrast, real-time with image documentation (2d), includes m-mode                                                                                                                                                                                                                                              
C8929003004recording, when performed, complete, with spectral doppler echocardiography,                                                                                                                                                                                                                                         
C8929004004and with color flow doppler echocardiography                                                                                                                                                                                                                                                                         
C8930001003Transthoracic echocardiography, with contrast, or without contrast followed by  Tte w or w/o contr, cont ecg53      A                                          1833(t)(2)                                                 D                          I3C 4      02009010120090101        N                           
C8930002004with contrast, real-time with image documentation (2d), includes m-mode                                                                                                                                                                                                                                              
C8930003004recording, when performed, during rest and cardiovascular stress test using                                                                                                                                                                                                                                          
C8930004004treadmill, bicycle exercise and/or pharmacologically induced stress, with                                                                                                                                                                                                                                            
C8930005004interpretation and report; including performance of continuous                                                                                                                                                                                                                                                       
C8930006004electrocardiographic monitoring, with physician supervision                                                                                                                                                                                                                                                          
C8931001003Magnetic resonance angiography with contrast, spinal canal and contents         Mra, w/dye, spinal canal    53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N                           
C8932001003Magnetic resonance angiography without contrast, spinal canal and contents      Mra, w/o dye, spinal canal  53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N                           
C8933001003Magnetic resonance angiography without contrast followed by with contrast,      Mra, w/o&w/dye, spinal canal53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N                           
C8933002004spinal canal and contents                                                                                                                                                                                                                                                                                            
C8934001003Magnetic resonance angiography with contrast, upper extremity                   Mra, w/dye, upper extremity 53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N                           
C8935001003Magnetic resonance angiography without contrast, upper extremity                Mra, w/o dye, upper extr    53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N                           
C8936001003Magnetic resonance angiography without contrast followed by with contrast,      Mra, w/o&w/dye, upper extr  53      A                                          1833(t)                                                    DYY20101001                I2D 4      02010100120101001        N                           
C8936002004upper extremity                                                                                                                                                                                                                                                                                                      
C8937001003Computer-aided detection, including computer algorithm analysis of breast mri   Cad breast mri              53      A                                          1833(t)                           0159T                    D                          I2D 4      02019010120190101        A                           
C8937002004image data for lesion detection/characterization, pharmacokinetic analysis,                                                                                                                                                                                                                                          
C8937003004with further physician review for interpretation (list separately in addition                                                                                                                                                                                                                                        
C8937004004to code for primary procedure)                                                                                                                                                                                                                                                                                       
C8957001003Intravenous infusion for therapy/diagnosis; initiation of prolonged infusion    Prolonged iv inf, req pump  99      9                                          1833(t)                                                    D                          P6D 1      02006010120060101        N                           
C8957002004(more than 8 hours), requiring use of portable or implantable pump                                                                                                                                                                                                                                                   
C9014001003Injection, cerliponase alfa, 1 mg                                               Injection, cerliponase alfa 53      A                                          1833(t)                           J0567                    DYY20180101                O1E 9F     0201801012019010120181231D                           
C9015001003Injection, c-1 esterase inhibitor (human), haegarda, 10 units                   C-1 esterase, haegarda      53      A                                          1833(t)                           J0599                    DYY20180101                O1E 9F     0201801012019010120181231D                           
C9016001003Injection, triptorelin extended release, 3.75 mg                                Inj, triptorelin ext rel    53      A                                          1833(t)                           J3316                    DYY20180101                O1E 9F     0201801012019010120181231D                           
C9021001003Injection, obinutuzumab, 10 mg                                                  Injection, obinutuzumab     53      A                                          1833(t)                                                    D                          O1D 9F     0201404012015010120141231N                           
C9022001003Injection, elosulfase alfa, 1mg                                                 Injection, elosulfase alfa  53      A                                          1833(t)                           J1322                    D                          O1E 9F     0201407012015010120141231N                           
C9023001003Injection, testosterone undecanoate, 1 mg                                       Inj testosterone undecanoate53      A                                          1833(t)                           J3145                    D                          O1E 9F     0201410012015010120141231N                           
C9024001003Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine                  Inj, daunorubicin-cytarabine53      A                                          1833(t)                           J9153                    DYY20180101                O1D 9F     0201801012019010120181231D                           
C9025001003Injection, ramucirumab, 5 mg                                                    Injection, ramucirumab      53      A                                          1833(t)                           J9308                    D                          O1D 9F     0201410012016010120151231N                           
C9026001003Injection, vedolizumab, 1 mg                                                    Injection, vedolizumab      53      A                                          1833(t)                           J3380                    D                          O1E 9F     0201410012016010120151231N                           
C9027001003Injection, pembrolizumab, 1 mg                                                  Injection, pembrolizumab    53      A                                          1833(t)                           J9271                    D                          O1E 9F     0201501012016010120151231N                           
C9028001003Injection, inotuzumab ozogamicin, 0.1 mg                                        Inj. inotuzumab ozogamicin  53      A                                          1833(t)                           J9229                    DYY20180101                O1D 9F     0201801012019010120181231D                           
C9029001003Injection, guselkumab, 1 mg                                                     Injection, guselkumab       53      A                                          1833(t)                           J1628                    DYY20180101                O1E 9F     0201801012019010120181231D                           
C9030001003Injection, copanlisib, 1 mg                                                     Inj copanlisib              53      A                                          1833(t)                           J9057                    D                          O1D 9F     0201807012019010120181231D                           
C9031001003Lutetium lu 177, dotatate, therapeutic, 1 mci                                   Lutetium lu 177 dotatate, tx53      A                                          1833(t)                           A9513                    D                          O1D 9F     0201807012019010120181231D                           
C9032001003Injection, voretigene neparvovec-rzyl, 1 billion vector genome                  Voretigene neparvovec-rzyl  53      A                                          1833(t)                           J3398                    D                          O1E 9F     0201807012019010120181231D                           
C9033001003Injection, fosnetupitant 235 mg and palonosetron 0.25 mg                        Inj, akynzeo                53      A                                          1833(t)                           J1454                    D                          O1E 9F     0201810012019010120181231D                           
C9034001003Injection, dexamethasone 9%, intraocular, 1 mcg                                 Injection, dexamethasone 9% 53      A                                          1833(t)                                                    DYY20181001                O1E 9F     02018100120181001        A                           
C9035001003Injection, aripiprazole lauroxil (aristada initio), 1 mg                        Injection, aristada initio  53      A                                          1833(t)                                                    DYY20190101                O1E 9F     02019010120190101        A                           
C9036001003Injection, patisiran, 0.1 mg                                                    Injection, patisiran        53      A                                          1833(t)                                                    DYY20190101                O1E 9F     02019010120190101        A                           
C9037001003Injection, risperidone (perseris), 0.5 mg                                       Injection, risperidone      53      A                                          1833(t)                                                    DYY20190101                O1E 9F     02019010120190101        A                           
C9038001003Injection, mogamulizumab-kpkc, 1 mg                                             Inj mogamulizumab-kpkc      53      A                                          1833(t)                                                    DYY20190101                O1E 9F     02019010120190101        A                           
C9039001003Injection, plazomicin, 5 mg                                                     Injection, plazomicin       53      A                                          1833(t)                                                    DYY20190101                O1E 9F     02019010120190101        A                           
C9113001003Injection, pantoprazole sodium, per vial                                        Inj pantoprazole sodium, via53      A                                          1833(T)                                                    D                          O1E 9      02002010120020101        N                           
C9121001003Injection, argatroban, per 5 mg                                                 Injection, argatroban       53      A                                          1833(T)                           J0883                    D                      0093O1E 1P     0200301012017010120161231N                           
C9132001003Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activityKcentra, per i.u.           53      A                                          1833(t)                                                    DYY20131001                O1E 1F     02013100120131001        N                           
C9133001003Factor ix (antihemophilic factor, recombinant), rixubis, per i.u.               Factor ix recombinant       53      A                                          1833(t)                           J7200                    D                          O1E 9F     0201401012015010120141231N                           
C9134001003Factor xiii (antihemophilic factor, recombinant), tretten, per 10 i.u.          Factor xiii a-subunit recomb53      A                                          1833(t)                           J7181                    D                          O1E 9F     0201407012015010120141231N                           
C9135001003Factor ix (antihemophilic factor, recombinant), alprolix, per i.u.              Factor ix (alprolix)        53      A                                          1833(t)                           J7201                    D                          O1E 9F     0201410012015010120141231N                           
C9136001003Injection, factor viii, fc fusion protein, (recombinant), per i.u.              Factor viii (eloctate)      53      A                                          1833(t)                           Q9975                    D                          O1E 9F     0201501012015040120150331N                           
C9137001003Injection, factor viii (antihemophilic factor, recombinant) pegylated, 1 i.u.   Adynovate factor viii recom 53      A                                          1833(T)                           J7207                    D                          O1E 9F     0201604012017010120161231N                           
C9138001003Injection, factor viii (antihemophilic factor, recombinant) (nuwiq), 1 i.u.     Nuwiq factor viii recomb    53      A                                          1833(T)                           J7209                    D                          O1E 9F     0201604012017010120161231N                           
C9139001003Injection, factor ix, albumin fusion protein (recombinant), idelvion, 1 i.u.    Idelvion, 1 i.u.            53      A                                          1833(t)                           J7202                    D                          O1E 9F     0201610012017010120161231N                           
C9140001003Injection, factor viii (antihemophilic factor, recombinant) (afstyla), 1 i.u.   Afstyla factor viii recomb  53      A                                          1833(T)                           J7210                    D                          O1E 9F     0201701012018010120171231N                           
C9248001003Injection, clevidipine butyrate, 1 mg                                           Inj, clevidipine butyrate   53      A                                          1833(t)                                                    DYY20190101                O1E 1      02009010120190101        P                           
C9250001003Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml     Artiss fibrin sealant       53      A                                          621MMA                                                     DYY20170101                O1E 9      02009070120170101        N                           
C9254001003Injection, lacosamide, 1 mg                                                     Injection, lacosamide       53      A                                          621MMA                                                     D                          O1E 9      02010010120100101        N                           
C9257001003Injection, bevacizumab, 0.25 mg                                                 Bevacizumab injection       53      A                                          1833(t)                                                    DYY20100101                O1E 9      02010010120100101        N                           
C9275001003Injection, hexaminolevulinate hydrochloride, 100 mg, per study dose             Hexaminolevulinate hcl      53      A                                          1833(t)                           A9589                    D                          O1E 4      0201101012019010120181231D                           
C9285001003Lidocaine 70 mg/tetracaine 70 mg, per patch                                     Patch, lidocaine/tetracaine 53      A                                          1833(t)                                                    D                      0093O1E 1      02011070120140101        N                           
C9290001003Injection, bupivacaine liposome, 1 mg                                           Inj, bupivacaine liposome   53      A                                          1833(t)                                                    DYY20190101                O1E 1      02012040120190101        P                           
C9293001003Injection, glucarpidase, 10 units                                               Injection, glucarpidase     53      A                                          1833(t)                                                    DYY20121001                O1E 1      02012100120121001        N                           
C9349001003Puraply, and puraply antimicrobial, any type, per square centimeter             Puraply, puraply antimic    53      A                                          1833(t)                           Q4172                    D                          O1E 9F     0201501012017010120161231N                           
C9352001003Microporous collagen implantable tube (neuragen nerve guide), per centimeter    Neuragen nerve guide, per cm53      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N                           
C9352002004length                                                                                                                                                                                                                                                                                                               
C9353001003Microporous collagen implantable slit tube (neurawrap nerve protector), per     Neurawrap nerve protector,cm53      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N                           
C9353002004centimeter length                                                                                                                                                                                                                                                                                                    
C9354001003Acellular pericardial tissue matrix of non-human origin (veritas), per square   Veritas collagen matrix, cm253      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N                           
C9354002004centimeter                                                                                                                                                                                                                                                                                                           
C9355001003Collagen nerve cuff (neuromatrix), per 0.5 centimeter length                    Neuromatrix nerve cuff, cm  53      A                                          621MMA                                                     D                          D1A 9      02008010120080101        N                           
C9356001003Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix     Tenoglide tendon prot, cm2  53      A                                          621 MMA                                                    D                          D1A 9      02008070120080701        N                           
C9356002004(tenoglide tendon protector sheet), per square centimeter                                                                                                                                                                                                                                                            
C9358001003Dermal substitute, native, non-denatured collagen, fetal bovine origin          Surgimend, fetal            53      A                                          621  MMA                                                   D                          D1A 9      02008070120140101        N                           
C9358002004(surgimend collagen matrix), per 0.5 square centimeters                                                                                                                                                                                                                                                              
C9359001003Porous purified collagen matrix bone void filler (integra mozaik                Implnt,bon void filler-putty53      A                                          1833(T)                                                    D                          D1A 9      02008100120081001        N                           
C9359002004osteoconductive scaffold putty, integra os osteoconductive scaffold putty), per                                                                                                                                                                                                                                      
C93590030040.5 cc                                                                                                                                                                                                                                                                                                               
C9360001003Dermal substitute, native, non-denatured collagen, neonatal bovine origin       Surgimend, neonatal         53      A                                          621MMA                                                     D                          D1A 9      02009070120140101        N                           
C9360002004(surgimend collagen matrix), per 0.5 square centimeters                                                                                                                                                                                                                                                              
C9361001003Collagen matrix nerve wrap (neuromend collagen nerve wrap), per 0.5 centimeter  Neuromend nerve wrap        53      A                                          621MMA                                                     D                          D1A 9      02009070120090701        N                           
C9361002004length                                                                                                                                                                                                                                                                                                               
C9362001003Porous purified collagen matrix bone void filler (integra mozaik                Implnt,bon void filler-strip53      A                                          621MMA                                                     D                          D1A 9      02009070120090701        N                           
C9362002004osteoconductive scaffold strip), per 0.5 cc                                                                                                                                                                                                                                                                          
C9363001003Skin substitute, integra meshed bilayer wound matrix, per square centimeter     Integra meshed bil wound mat53      A                                          621MMA                                                     D                          D1A 9      02009070120140101        N                           
C9364001003Porcine implant, permacol, per square centimeter                                Porcine implant, permacol   53      A                                          621MMA                                                     D                          D1A 9      02009070120090701        N                           
C9399001003Unclassified drugs or biologicals                                               Unclassified drugs or biolog53      A                                          621MMA                                                     DYY20080101                O1E 1      02004010120040101        N                           
C9407001003Iodine i-131 iobenguane, diagnostic, 1 millicurie                               Iodine i-131 iobenguane, dx 53      A                                          1833(t)                                                    DYY20190101                I1E 4      02019010120190101        A                           
C9408001003Iodine i-131 iobenguane, therapeutic, 1 millicurie                              Iodine i-131 iobenguane, tx 53      A                                          1833(t)                                                    DYY20190101                I1E 4      02019010120190101        A                           
C9441001003Injection, ferric carboxymaltose, 1 mg                                          Inj, ferric carboxymaltose  53      A                                          1833(t)                                                    D                          O1E 9F     0201401012014070120140630N                           
C9442001003Injection, belinostat, 10 mg                                                    Injection, belinostat       53      A                                          1833(t)                           J9032                    D                          O1D 9F     0201501012016010120151231N                           
C9443001003Injection, dalbavancin, 10 mg                                                   Injection, dalbavancin      53      A                                          1833(t)                           J0875                    D                          O1E 9F     0201501012016010120151231N                           
C9444001003Injection, oritavancin, 10 mg                                                   Injection, oritavancin      53      A                                          1833(t)                           J2407                    D                          O1E 9F     0201501012016010120151231N                           
C9445001003Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units             C-1 esterase, ruconest      53      A                                          1833(t)                           J0596                    D                          O1E 9F     0201504012016010120151231N                           
C9446001003Injection, tedizolid phosphate, 1 mg                                            Inj, tedizolid phosphate    53      A                                          1833(t)                           J3090                    D                          O1E 9F     0201501012016010120151231N                           
C9447001003Injection, phenylephrine and ketorolac, 4 ml vial                               Inj, phenylephrine ketorolac53      A                                          1833(t)                                                    DYY20181001                O1E 9F     02015010120181001        P                           
C9448001003Netupitant 300 mg and palonosetron 0.5 mg, oral                                 Oral netupitant palonosetron53      A                                          1833(t)                           Q9978                    D                          O1E 9F     0201504012015070120150630N                           
C9449001003Injection, blinatumomab, 1 mcg                                                  Inj, blinatumomab           53      A                                          1833(t)                           J9039                    D                          O1D 9F     0201504012016010120151231N                           
C9450001003Injection, fluocinolone acetonide intravitreal implant, 0.01 mg                 Fluocinolone acetonide implt53      A                                          1833(t)                           J7313                    D                          O1E 9F     0201504012016010120151231N                           
C9451001003Injection, peramivir, 1 mg                                                      Injection, peramivir        53      A                                          1833(t)                           J2547                    D                          O1E 9F     0201504012016010120151231N                           
C9452001003Injection, ceftolozane 50 mg and tazobactam 25 mg                               Inj, ceftolozane/tazobactam 53      A                                          1833(t)                           J0695                    D                          O1E 9F     0201504012016010120151231N                           
C9453001003Injection, nivolumab, 1 mg                                                      Injection, nivolumab        53      A                                          1833(t)                           J9299                    D                          O1D 9F     0201507012016010120151231N                           
C9454001003Injection, pasireotide long acting, 1 mg                                        Inj, pasireotide long acting53      A                                          1833(t)                           J2502                    D                          O1E 9F     0201507012016010120151231N                           
C9455001003Injection, siltuximab, 10 mg                                                    Injection, siltuximab       53      A                                          1833(t)                           J2860                    D                          O1D 9F     0201507012016010120151231N                           
C9456001003Injection, isavuconazonium sulfate, 1 mg                                        Inj, isavuconazonium sulfate53      A                                          1833(t)                           J1833                    D                          O1E 9F     0201510012016010120151231N                           
C9457001003Injection, sulfur hexafluoride lipid microsphere, per ml                        Lumason contrast agent      53      A                                          1833(t)                           Q9950                    D                          O1E 4F     0201510012016010120151231N                           
C9458001003Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries              Florbetaben f18             53      A                                          1833(t)                           Q9983                    D                          O1E 4F     0201601012016070120160630N                           
C9459001003Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries               Flutemetamol f18            53      A                                          1833(t)                           Q9982                    D                          O1E 4F     0201601012016070120160630N                           
C9460001003Injection, cangrelor, 1 mg                                                      Injection, cangrelor        53      A                                          1833(t)                                                    DYY20160101                O1E 1F     02016010120160101        N                           
C9461001003Choline c 11, diagnostic, per study dose                                        Choline c 11, diagnostic    53      A                                          1833(T)                           A9515                    D                          I1E 4F     0201604012017010120161231N                           
C9462001003Injection, delafloxacin, 1 mg                                                   Injection, delafloxacin     53      A                                          1833(t)                                                    DYY20180401                O1E 9F     02018040120180401        A                           
C9463001003Injection, aprepitant, 1 mg                                                     Injection, aprepitant       53      A                                          1833(t)                           J0185                    D                          O1E 9F     0201804012019010120181231D                           
C9464001003Injection, rolapitant, 0.5 mg                                                   Injection, rolapitant       53      A                                          1833(t)                           J2797                    D                          O1E 9F     0201804012019010120181231D                           
C9465001003Hyaluronan or derivative, durolane, for intra-articular injection, per dose     Injection, durolane         53      A                                          1833(t)                           J7318                    D                          O1E 9F     0201804012019010120181231D                           
C9466001003Injection, benralizumab, 1 mg                                                   Injection, benralizumab     53      A                                          1833(t)                           J0517                    D                          O1E 9F     0201804012019010120181231D                           
C9467001003Injection, rituximab and hyaluronidase, 10 mg                                   Inj rituximab hyaluronidase 53      A                                          1833(t)                           J9311                    D                          O1E 9F     0201804012019010120181231D                           
C9468001003Injection, factor ix (antihemophilic factor, recombinant), glycopegylated,      Inj, factor ix, rebinyn     53      A                                          1833(t)                           J7023                    D                          O1E 9F     0201804012019010120181231D                           
C9468002004rebinyn, 1 i.u.                                                                                                                                                                                                                                                                                                      
C9469001003Injection, triamcinolone acetonide, preservative-free, extended-release,        Inj triamcinolone acetonide 53      A                                          1833(t)                           Q9993                    D                          O1E 9F     0201804012018070120180630D                           
C9469002004microsphere formulation, 1 mg                                                                                                                                                                                                                                                                                        
C9470001003Injection, aripiprazole lauroxil, 1 mg                                          Aripiprazole lauroxil im    53      A                                          1833(T)                           J1942                    D                          O1E 9F     0201604012017010120161231N                           
C9471001003Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg          Hymovis, 1 mg               53      A                                          1833(T)                           J7322                    D                          O1E 9F     0201604012017010120161231N                           
C9472001003Injection, talimogene laherparepvec, 1 million plaque forming units (pfu)       Inj talimogene laherparepvec53      A                                          1833(T)                           J9325                    D                          O1D 9F     0201604012017010120161231N                           
C9473001003Injection, mepolizumab, 1 mg                                                    Injection, mepolizumab      53      A                                          1833(T)                           J2182                    D                          O1E 9F     0201604012017010120161231N                           
C9474001003Injection, irinotecan liposome, 1 mg                                            Inj, irinotecan liposome    53      A                                          1833(T)                           J9205                    D                          O1D 9F     0201604012017010120161231N                           
C9475001003Injection, necitumumab, 1 mg                                                    Injection, necitumumab      53      A                                          1833(T)                           J9295                    D                          O1D 9F     0201604012017010120161231N                           
C9476001003Injection, daratumumab, 10 mg                                                   Injection, daratumumab      53      A                                          1833(t)                           J9145                    D                          O1D 9F     0201607012017010120161231N                           
C9477001003Injection, elotuzumab, 1 mg                                                     Injection, elotuzumab       53      A                                          1833(t)                           J9176                    D                          O1D 9F     0201607012017010120161231N                           
C9478001003Injection, sebelipase alfa, 1 mg                                                Injection, sebelipase alfa  53      A                                          1833(t)                           J2840                    D                          O1E 9F     0201607012017010120161231N                           
C9479001003Instillation, ciprofloxacin otic suspension, 6 mg                               Instill, ciprofloxacin otic 53      A                                          1833(t)                           J7342                    D                          O1E 9F     0201607012017010120161231N                           
C9480001003Injection, trabectedin, 0.1 mg                                                  Injection, trabectedin      53      A                                          1833(t)                           J9352                    D                          O1D 9F     0201607012017010120161231N                           
C9481001003Injection, reslizumab, 1 mg                                                     Injection, reslizumab       53      A                                          1833(t)                           J2786                    D                          O1E 9F     0201610012017010120161231N                           
C9482001003Injection, sotalol hydrochloride, 1 mg                                          Sotalol hydrochloride iv    53      A                                          1833(t)                                                    DYY20161001                O1E 9F     02016100120161001        N                           
C9483001003Injection, atezolizumab, 10 mg                                                  Injection, atezolizumab     53      A                                          1833(t)                           J9022                    D                          O1D 9F     0201610012018010120171231N                           
C9484001003Injection, eteplirsen, 10 mg                                                    Injection, eteplirsen       53      A                                          1833(t)                           J1428                    D                          O1E 9F     0201704012018010120171231N                           
C9485001003Injection, olaratumab, 10 mg                                                    Injection, olaratumab       53      A                                          1833(t)                           J9285                    D                          O1D 9F     0201704012018010120171231N                           
C9486001003Injection, granisetron extended release, 0.1 mg                                 Inj, granisetron ext        53      A                                          1833(t)                           J1627                    D                          O1E 9F     0201704012018010120171231N                           
C9487001003Ustekinumab, for intravenous injection, 1 mg                                    Ustekinumab iv inj, 1 mg    53      A                                          1833(t)                           Q9989                    D                          O1E 9F     0201704012017070120170630N                           
C9488001003Injection, conivaptan hydrochloride, 1 mg                                       Conivaptan hcl              53      A                                          1833(t)                                                    DYY20170401                O1E 9F     02017040120170401        N                           
C9489001003Injection, nusinersen, 0.1 mg                                                   Injection, nusinersen       53      A                                          1833(t)                           J2326                    D                          O1E 9F     0201707012018010120171231N                           
C9490001003Injection, bezlotoxumab, 10 mg                                                  Injection, bezlotoxumab     53      A                                          1833(t)                           J0565                    D                          O1E 9F     0201707012018010120171231N                           
C9491001003Injection, avelumab, 10 mg                                                      Injection, avelumab         53      A                                          1833(t)                           J9023                    D                          O1D 9F     0201710012018010120171231N                           
C9492001003Injection, durvalumab, 10 mg                                                    Injection, durvalumab       53      A                                          1833(t)                           J9173                    DYY20171001                O1D 9F     0201710012019010120181231D                           
C9493001003Injection, edaravone, 1 mg                                                      Injection, edaravone        53      A                                          1833(t)                           J1301                    DYY20171001                O1E 9F     0201710012019010120181231D                           
C9494001003Injection, ocrelizumab, 1 mg                                                    Injection, ocrelizumab      53      A                                          1833(t)                           J2350                    D                          O1E 9F     0201710012018010120171231N                           
C9497001003Loxapine, inhalation powder, 10 mg                                              Loxapine, inhalation powder 53      A                                          1833(t)                           J2062                    DYY20140101                O1E 9F     0201401012019010120181231D                           
C9600001003Percutaneous transcatheter placement of drug eluting intracoronary stent(s),    Perc drug-el cor stent sing 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9600002004with coronary angioplasty when performed; single major coronary artery or branch                                                                                                                                                                                                                                     
C9601001003Percutaneous transcatheter placement of drug-eluting intracoronary stent(s),    Perc drug-el cor stent bran 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9601002004with coronary angioplasty when performed; each additional branch of a major                                                                                                                                                                                                                                          
C9601003004coronary artery (list separately in addition to code for primary procedure)                                                                                                                                                                                                                                          
C9602001003Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary Perc d-e cor stent ather s  53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9602002004stent, with coronary angioplasty when performed; single major coronary artery                                                                                                                                                                                                                                        
C9602003004or branch                                                                                                                                                                                                                                                                                                            
C9603001003Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary Perc d-e cor stent ather br 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9603002004stent, with coronary angioplasty when performed; each additional branch of a                                                                                                                                                                                                                                         
C9603003004major coronary artery (list separately in addition to code for primary                                                                                                                                                                                                                                               
C9603004004procedure)                                                                                                                                                                                                                                                                                                           
C9604001003Percutaneous transluminal revascularization of or through coronary artery       Perc d-e cor revasc t cabg s53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9604002004bypass graft (internal mammary, free arterial, venous), any combination of                                                                                                                                                                                                                                           
C9604003004drug-eluting intracoronary stent, atherectomy and angioplasty, including distal                                                                                                                                                                                                                                      
C9604004004protection when performed; single vessel                                                                                                                                                                                                                                                                             
C9605001003Percutaneous transluminal revascularization of or through coronary artery       Perc d-e cor revasc t cabg b53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9605002004bypass graft (internal mammary, free arterial, venous), any combination of                                                                                                                                                                                                                                           
C9605003004drug-eluting intracoronary stent, atherectomy and angioplasty, including distal                                                                                                                                                                                                                                      
C9605004004protection when performed; each additional branch subtended by the bypass graft                                                                                                                                                                                                                                      
C9605005004(list separately in addition to code for primary procedure)                                                                                                                                                                                                                                                          
C9606001003Percutaneous transluminal revascularization of acute total/subtotal occlusion   Perc d-e cor revasc w ami s 53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9606002004during acute myocardial infarction, coronary artery or coronary artery bypass                                                                                                                                                                                                                                        
C9606003004graft, any combination of drug-eluting intracoronary stent, atherectomy and                                                                                                                                                                                                                                          
C9606004004angioplasty, including aspiration thrombectomy when performed, single vessel                                                                                                                                                                                                                                         
C9607001003Percutaneous transluminal revascularization of chronic total occlusion,         Perc d-e cor revasc chro sin53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9607002004coronary artery, coronary artery branch, or coronary artery bypass graft, any                                                                                                                                                                                                                                        
C9607003004combination of drug-eluting intracoronary stent, atherectomy and                                                                                                                                                                                                                                                     
C9607004004angioplasty; single vessel                                                                                                                                                                                                                                                                                           
C9608001003Percutaneous transluminal revascularization of chronic total occlusion,         Perc d-e cor revasc chro add53      A                                          1833(t)                                                    D                      0107P2F 2      02013010120130101        N                           
C9608002004coronary artery, coronary artery branch, or coronary artery bypass graft, any                                                                                                                                                                                                                                        
C9608003004combination of drug-eluting intracoronary stent, atherectomy and                                                                                                                                                                                                                                                     
C9608004004angioplasty; each additional coronary artery, coronary artery branch, or bypass                                                                                                                                                                                                                                      
C9608005004graft (list separately in addition to code for primary procedure)                                                                                                                                                                                                                                                    
C9724001003Endoscopic full-thickness plication of the stomach using endoscopic plication   Eps stomach plic            53      A                                          1833(T)                           43210                    D                          P8I 2      0200504012016010120151231N                           
C9724002004system (eps); includes endoscopy                                                                                                                                                                                                                                                                                     
C9725001003Placement of endorectal intracavitary applicator for high intensity             Place endorectal app        53      A                                          1833(T)                                                    DYY20080101                P7A 6      02005100120051001        N                           
C9725002004brachytherapy                                                                                                                                                                                                                                                                                                        
C9726001003Placement and removal (if performed) of applicator into breast for              Rxt breast appl place/remov 53      A                                          1833(T)                                                    D                          P7A 6      02006010120140101        N                           
C9726002004intraoperative radiation therapy, add-on to primary breast procedure                                                                                                                                                                                                                                                 
C9727001003Insertion of implants into the soft palate; minimum of three implants           Insert palate implants      53      A                                          1833(T)                                                    DYY20080101                P6D 2      02006100120061001        N                           
C9728001003Placement of interstitial device(s) for radiation therapy/surgery guidance      Place device/marker, non pro53      A                                          1833(T)                                                    DYY20130101                P5E 2      02007070120100101        N                           
C9728002004(e.g., fiducial markers, dosimeter), for other than the following sites (any                                                                                                                                                                                                                                         
C9728003004approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or                                                                                                                                                                                                                                             
C9728004004multiple                                                                                                                                                                                                                                                                                                             
C9733001003Non-ophthalmic fluorescent vascular angiography                                 Non-ophthalmic fva          53      A                                          1833(t)                                                    D                          I4B 4      02012040120120401        N                           
C9734001003Focused ultrasound ablation/therapeutic intervention, other than uterine        U/s trtmt, not leiomyomata  53      A                                          1833(t)                                                    D                          P5E 2      02013040120130701        N                           
C9734002004leiomyomata, with magnetic resonance (mr) guidance                                                                                                                                                                                                                                                                   
C9735001003Anoscopy; with directed submucosal injection(s), any substance                  Anoscopy, submucosal inj    53      A                                          1833(t)                           0377T                    D                          P8I 2      0201304012015010120141231N                           
C9737001003Laparoscopy, surgical, esophageal sphincter augmentation with device (e.g.,     Lap esoph augmentation      53      A                                          1833(t)                           0392T                    D                          O1E 2F     0201401012015070120150630N                           
C9737002004magnetic band)                                                                                                                                                                                                                                                                                                       
C9738001003Adjunctive blue light cystoscopy with fluorescent imaging agent  (list          Blue light cysto imag agent 53      A                                          1833(t)                                                    D                          I1F 1F     02018010120180101        N                           
C9738002004separately in addition to code for primary procedure)                                                                                                                                                                                                                                                                
C9739001003Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants    Cystoscopy prostatic imp 1-353      A                                          1833(t)                                                    DYY20140401                P5E 2F     02014040120140401        N                           
C9740001003Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants Cysto impl 4 or more        53      A                                          1833(t)                                                    DYY20140401                P5E 2F     02014040120140401        N                           
C9741001003Right heart catheterization with implantation of wireless pressure sensor in    Impl pressure sensor w/angio53      A                                          1833(t)                           33289                    D                          P6D 2F     0201410012019010120181231D                           
C9741002004the pulmonary artery, including any type of measurement, angiography, imaging                                                                                                                                                                                                                                        
C9741003004supervision, interpretation, and report                                                                                                                                                                                                                                                                              
C9742001003Laryngoscopy, flexible fiberoptic, with injection into vocal cord(s),           Laryngoscopy with injection 53      A                                          1833(t)                           3157331574               D                          P8H 2F     0201501012017010120161231N                           
C9742002004therapeutic, including diagnostic laryngoscopy, if performed                                                                                                                                                                                                                                                         
C9743001003Injection/implantation of bulking or spacer material (any type) with or without Bulking/spacer material impl53      A                                          1833(t)                           0438T                    D                          P6C 2F     0201510012016070120160630N                           
C9743002004image guidance (not to be used if a more specific code applies)                                                                                                                                                                                                                                                      
C9744001003Ultrasound, abdominal, with contrast                                            Abd us w/contrast           53      A                                          1833(t)                           7697876979               D                          I3B 4F     0201610012019010120181231D                           
C9745001003Nasal endoscopy, surgical; balloon dilation of eustachian tube                  Nasal endo eustachian tube  53      A                                          1833(t)                                                    DYY20170701                P8I 2F     02017070120170701        N                           
C9746001003Transperineal implantation of permanent adjustable balloon continence device,   Trans imp balloon cont      53      A                                          1833(t)                                                    DYY20170701                P6C 2F     02017070120170701        N                           
C9746002004with cystourethroscopy, when performed and/or fluoroscopy, when performed                                                                                                                                                                                                                                            
C9747001003Ablation of prostate, transrectal, high intensity focused ultrasound (hifu),    Ablation, hifu, prostate    53      A                                          1833(t)                                                    DYY20170701                P6C 2F     02017070120170701        N                           
C9747002004including imaging guidance                                                                                                                                                                                                                                                                                           
C9748001003Transurethral destruction of prostate tissue; by radiofrequency water vapor     Prostatic rf water vapor tx 53      A                                          1833(t)                           53854                    D                          P5E 2F     0201801012019010120181231D                           
C9748002004(steam) thermal therapy                                                                                                                                                                                                                                                                                              
C9749001003Repair of nasal vestibular lateral wall stenosis with implant(s)                Repair nasal stenosis w/imp 53      A                                          1833(t)                                                    DYY20180401                P5E 2F     02018040120180401        A                           
C9750001003Insertion or removal and replacement of intracardiac ischemia monitoring system Ins/rem-replace compl iims  53      A                                          1833(t)                           0525T                    D                          P6C 2F     0201810012019010120181231D                           
C9750002004including imaging supervision and interpretation and peri-operative                                                                                                                                                                                                                                                  
C9750003004interrogation and programming; complete system (includes device and electrode)                                                                                                                                                                                                                                       
C9751001003Bronchoscopy, rigid or flexible, transbronchial ablation of lesion(s) by        Microwave bronch, 3d, ebus  53      A                                          1833(t)                                                    D                          P8F 2      02019010120190101        A                           
C9751002004microwave energy, including  fluoroscopic guidance, when performed, with                                                                                                                                                                                                                                             
C9751003004computed tomography acquisition(s) and 3-d rendering, computer-assisted,                                                                                                                                                                                                                                             
C9751004004image-guided navigation, and endobronchial ultrasound (ebus) guided                                                                                                                                                                                                                                                  
C9751005004transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies])                                                                                                                                                                                                                                         
C9751006004and all mediastinal and/or hilar lymph node stations or structures and                                                                                                                                                                                                                                               
C9751007004therapeutic intervention(s)                                                                                                                                                                                                                                                                                          
C9752001003Destruction of intraosseous basivertebral nerve, first two vertebral bodies,    Intraosseous des lumb/sacrum53      A                                          1833(t)                                                    DYY20190101                P5B 2      02019010120190101        A                           
C9752002004including imaging guidance (e.g., fluoroscopy), lumbar/sacrum                                                                                                                                                                                                                                                        
C9753001003Destruction of intraosseous basivertebral nerve, each additional vertebral      Intraosseous destruct add'l 53      A                                          1833(t)                                                    D                          P5B 2      02019010120190101        A                           
C9753002004body, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum (list                                                                                                                                                                                                                                            
C9753003004separately in addition to code for primary procedure)                                                                                                                                                                                                                                                                
C9754001003Creation of arteriovenous fistula,  percutaneous; direct, any site, including   Perc av fistula, direct     53      A                                          1833(t)                                                    DYY20190101                P5E 2      02019010120190101        A                           
C9754002004all imaging and radiologic supervision and interpretation, when performed and                                                                                                                                                                                                                                        
C9754003004secondary procedures to redirect blood flow (e.g., transluminal balloon                                                                                                                                                                                                                                              
C9754004004angioplasty, coil embolization, when performed)                                                                                                                                                                                                                                                                      
C9755001003Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial  Rf magnetic-guide av fistula53      A                                          1833(t)                                                    DYY20190101                P5E 2      02019010120190101        A                           
C9755002004and venous catheters and radiofrequency energy, including flow-directing                                                                                                                                                                                                                                             
C9755003004procedures (e.g., vascular coil embolization with radiologic supervision and                                                                                                                                                                                                                                         
C9755004004interpretation, when performed) and fistulogram(s), angiography, venography,                                                                                                                                                                                                                                         
C9755005004and/or ultrasound, with radiologic supervision and interpretation, when                                                                                                                                                                                                                                              
C9755006004performed                                                                                                                                                                                                                                                                                                            
C9800001003Dermal injection procedure(s) for facial lipodystrophy syndrome (lds) and       Dermal filler inj px/suppl  53      A                                          1833(t)                           G0429                    D                      0093P6A 1      0201007012017010120161231N                           
C9800002004provision of radiesse or sculptra dermal filler, including all items and                                                                                                                                                                                                                                             
C9800003004supplies                                                                                                                                                                                                                                                                                                             
C9898001003Radiolabeled product provided during a hospital inpatient stay                  Inpnt stay radiolabeled item00      9                                          NA                                                         D                          Z2  1      02008010120080101        N                           
C9899001003Implanted prosthetic device, payable only for inpatients who do not have        Inpt implant pros dev,no cov53      A                                          1833(t)                                                    D                          Z2  1      02009010120090101        N                           
C9899002004inpatient coverage                                                                                                                                                                                                                                                                                                   
E0100001003Cane, includes canes of all materials, adjustable or fixed, with tip            Cane adjust/fixed with tip  32      A60-3  60-9        2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0105001003Cane, quad or three prong, includes canes of all materials, adjustable or       Cane adjust/fixed quad/3 pro32      A60-15 60-9        2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0105002004fixed, with tips                                                                                                                                                                                                                                                                                                     
E0110001003Crutches, forearm, includes crutches of various materials, adjustable or fixed, Crutch forearm pair         32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0110002004pair, complete with tips and handgrips                                                                                                                                                                                                                                                                               
E0111001003Crutch forearm, includes crutches of various materials, adjustable or fixed,    Crutch forearm each         32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0111002004each, with tip and handgrips                                                                                                                                                                                                                                                                                         
E0112001003Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and         Crutch underarm pair wood   32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0112002004handgrips                                                                                                                                                                                                                                                                                                            
E0113001003Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip    Crutch underarm each wood   32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0114001003Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips  Crutch underarm pair no wood32      A60-9              2100.1                                                                             D                          D1E APR    01986010119970101        N                           
E0114002004and handgrips                                                                                                                                                                                                                                                                                                        
E0116001003Crutch, underarm, other than wood, adjustable or fixed, with pad, tip,          Crutch underarm each no wood32      A60-9              2100.1                                                                             D                          D1E APR    01986010120060101        N                           
E0116002004handgrip, with or without shock absorber, each                                                                                                                                                                                                                                                                       
E0117001003Crutch, underarm, articulating, spring assisted, each                           Underarm springassist crutch36      A                  2100.1                                                                             D                          D1E APR    02003010120140401        N                           
E0118001003Crutch substitute, lower leg platform, with or without wheels, each             Crutch substitute           32      A                                                                                                     C                          D1E APR    02004010120040401        N                           
E0130001003Walker, rigid (pickup), adjustable or fixed height                              Walker rigid adjust/fixed ht32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0135001003Walker, folding (pickup), adjustable or fixed height                            Walker folding adjust/fixed 32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0140001003Walker, with trunk support, adjustable or fixed height, any type                Walker w trunk support      36      A60-9              2100.1                                                                             D                          D1E APR    02004010120160701        N                           
E0141001003Walker, rigid, wheeled, adjustable or fixed height                              Rigid wheeled walker adj/fix32      A60-9              2100.1                                                                             D                          D1E APR    01986010120040101        N                           
E0143001003Walker, folding, wheeled, adjustable or fixed height                            Walker folding wheeled w/o s32      A60-9              2100.1                                                                             D                          D1E APR    01986010120040101        N                           
E0144001003Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior   Enclosed walker w rear seat 36      A60-9              2100.1                                                                             D                          D1E APR    02000010120140401        N                           
E0144002004seat                                                                                                                                                                                                                                                                                                                 
E0147001003Walker, heavy duty, multiple braking system, variable wheel resistance          Walker variable wheel resist32      A60-15             2100.1                                                                             D                          D1E APR    01986010120040101        N                           
E0148001003Walker, heavy duty, without wheels, rigid or folding, any type, each            Heavyduty walker no wheels  32      A                                                                                                     C                          D1E APR    02001010120010101        N                           
E0149001003Walker, heavy duty, wheeled, rigid or folding, any type                         Heavy duty wheeled walker   36      A                                                                                                     C                          D1E APR    02001010120160701        N                           
E0153001003Platform attachment, forearm crutch, each                                       Forearm crutch platform atta32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0154001003Platform attachment, walker, each                                               Walker platform attachment  32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0155001003Wheel attachment, rigid pick-up walker, per pair                                Walker wheel attachment,pair32      A                                                                                                     C                          D1E APR    01986010120000101        N                           
E0156001003Seat attachment, walker                                                         Walker seat attachment      32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0157001003Crutch attachment, walker, each                                                 Walker crutch attachment    32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0158001003Leg extensions for walker, per set of four (4)                                  Walker leg extenders set of432      A                                                                                                     C                          D1E APR    01986010120000101        N                           
E0159001003Brake attachment for wheeled walker, replacement, each                          Brake for wheeled walker    32      A                                                                                                     C                          D1E APR    01997010119980101        N                           
E0160001003Sitz type bath or equipment, portable, used with or without commode             Sitz type bath or equipment 32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0161001003Sitz type bath or equipment, portable, used with or without commode, with       Sitz bath/equipment w/faucet32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0161002004faucet attachment/s                                                                                                                                                                                                                                                                                                  
E0162001003Sitz bath chair                                                                 Sitz bath chair             32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0163001003Commode chair, mobile or stationary, with fixed arms                            Commode chair with fixed arm32      A60-9              2100.1                                                                             D                          D1E APR    01986010120070101        N                           
E0165001003Commode chair, mobile or stationary, with detachable arms                       Commode chair with detacharm36      A60-9              2100.1                                                                             D                          D1E R      01986010120070101        N                           
E0167001003Pail or pan for use with commode chair, replacement only                        Commode chair pail or pan   32      A60-9                                                                                                 D                          D1E APR    01986010120070101        N                           
E0168001003Commode chair, extra wide and/or heavy duty, stationary or mobile, with or      Heavyduty/wide commode chair32      A                                                                                                     C                          D1E APR    02001010120010101        N                           
E0168002004without arms, any type, each                                                                                                                                                                                                                                                                                         
E0170001003Commode chair with integrated seat lift mechanism, electric, any type           Commode chair electric      36      A                                                                                                     C                          D1E APR    02006010120060101        N                           
E0171001003Commode chair with integrated seat lift mechanism, non-electric, any type       Commode chair non-electric  36      A                                                                                                     C                          D1E APR    02006010120060101        N                           
E0172001003Seat lift mechanism placed over or on top of toilet, any type                   Seat lift mechanism toilet  00      9                                          1861SSA                                                    S                          D1E APR    02006010120060101        N                           
E0175001003Foot rest, for use with commode chair, each                                     Commode chair foot rest     32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0181001003Powered pressure reducing mattress overlay/pad, alternating, with pump,         Press pad alternating w/ pum36      A60-9              4107.6                                                                             D                          D1E R      01986010120070101        N                           
E0181002004includes heavy duty                                                                                                                                                                                                                                                                                                  
E0182001003Pump for alternating pressure pad, for replacement only                         Replace pump, alt press pad 36      A60-9              4107.6                                                                             D                          D1E R      01986010120070101        N                           
E0184001003Dry pressure mattress                                                           Dry pressure mattress       32      A60-9              4107.6                                                                             D                          D1E APR    01986010119960101        N                           
E0185001003Gel or gel-like pressure pad for mattress, standard mattress length and width   Gel pressure mattress pad   32      A60-9              4107.6                                                                             D                          D1E APR    01986010119980101        N                           
E0186001003Air pressure mattress                                                           Air pressure mattress       36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0187001003Water pressure mattress                                                         Water pressure mattress     36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0188001003Synthetic sheepskin pad                                                         Synthetic sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR    01986010120010101        N                           
E0189001003Lambswool sheepskin pad, any size                                               Lambswool sheepskin pad     32      A60-9              4107.6                                                                             D                          D1E APR    01986010120010101        N                           
E0190001003Positioning cushion/pillow/wedge, any shape or size, includes all components    Positioning cushion         00      9                  2100.1                                                                             D                          D1E 9      02004010120070101        N                           
E0190002004and accessories                                                                                                                                                                                                                                                                                                      
E0191001003Heel or elbow protector, each                                                   Protector heel or elbow     32      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E0193001003Powered air flotation bed (low air loss therapy)                                Powered air flotation bed   36      A                                                                                                     C                          D1E R      01990010119930101        N                           
E0194001003Air fluidized bed                                                               Air fluidized bed           36      A60-19                                                                                                D                      0013D1E R      01991010119910101        N                           
E0196001003Gel pressure mattress                                                           Gel pressure mattress       36      A60-9                                                                                                 D                          D1E R      01991010119910101        N                           
E0197001003Air pressure pad for mattress, standard mattress length and width               Air pressure pad for mattres36      A60-9                                                                                                 D                          D1E APR    01991010120160701        N                           
E0198001003Water pressure pad for mattress, standard mattress length and width             Water pressure pad for mattr36      A60-9                                                                                                 D                          D1E APR    01991010120140401        N                           
E0199001003Dry pressure pad for mattress, standard mattress length and width               Dry pressure pad for mattres32      A60-9                                                                                                 D                          D1E APR    01991010119980101        N                           
E0200001003Heat lamp, without stand (table model), includes bulb, or infrared element      Heat lamp without stand     32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0202001003Phototherapy (bilirubin) light with photometer                                  Phototherapy light w/ photom36      A                                                                                                     C                          D1E R      01985010119960101        N                           
E0203001003Therapeutic lightbox, minimum 10,000 lux, table top model                       Therapeutic lightbox tabletp00      960-9                                                                                                 M                          D1E 9      02003010120050101        N                           
E0205001003Heat lamp, with stand, includes bulb, or infrared element                       Heat lamp with stand        32      A60-9              2100.1                                                                             D                          D1E APR    01986010119960101        N                           
E0210001003Electric heat pad, standard                                                     Electric heat pad standard  32      A60-9                                                                                                 D                          D1E ALP    01986010120030101        N                           
E0215001003Electric heat pad, moist                                                        Electric heat pad moist     32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0217001003Water circulating heat pad with pump                                            Water circ heat pad w pump  32      A60-9                                                                                                 D                          D1E APR    01997010119970101        N                           
E0218001003Fluid circulating cold pad with pump, any type                                  Fluid circ cold pad w pump  36      A60-9                                                                                                 D                          D1E APR    01997010120190101        C                           
E0221001003Infrared heating pad system                                                     Infrared heating pad system 00      9                                                                                                     C                          D1E APR    02002010120070101        N                           
E0225001003Hydrocollator unit, includes pads                                               Hydrocollator unit          32      A60-9              2210.3                                                                             D                          D1E APR    01986010119960101        N                           
E0231001003Non-contact wound warming device (temperature control unit, ac adapter and      Wound warming device        00      9                  2303                                                                               M                          D1E R      02002010120020701        N                           
E0231002004power cord) for use with warming card and wound cover                                                                                                                                                                                                                                                                
E0232001003Warming card for use with the non contact wound warming device and non contact  Warming card for nwt        00      9                  2303                                                                               M                          D1E P      02002010120020701        N                           
E0232002004wound warming wound cover                                                                                                                                                                                                                                                                                            
E0235001003Paraffin bath unit, portable (see medical supply code a4265 for paraffin)       Paraffin bath unit portable 36      A60-9              2210.3                                                                             D                          D1E R      01986010119960101        N                           
E0236001003Pump for water circulating pad                                                  Pump for water circulating p36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0239001003Hydrocollator unit, portable                                                    Hydrocollator unit portable 32      A60-9              2210.3                                                                             D                          D1E APR    01986010119960101        N                           
E0240001003Bath/shower chair, with or without wheels, any size                             Bath/shower chair           00      960-9                                                                                                 M                          D1E 9      02004010120060101        N                           
E0241001003Bath tub wall rail, each                                                        Bath tub wall rail          00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N                           
E0242001003Bath tub rail, floor base                                                       Bath tub rail floor         00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N                           
E0243001003Toilet rail, each                                                               Toilet rail                 00      960-9              2100.1                                                                             M                          D1E APR    01986010119960101        N                           
E0244001003Raised toilet seat                                                              Toilet seat raised          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N                           
E0245001003Tub stool or bench                                                              Tub stool or bench          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N                           
E0246001003Transfer tub rail attachment                                                    Transfer tub rail attachment00      9                                                                                                     C                          D1E APR    01986010119960101        N                           
E0247001003Transfer bench for tub or toilet with or without commode opening                Trans bench w/wo comm open  00      960-9                                                                                                 D                          D1E APR    02004010120040101        N                           
E0248001003Transfer bench, heavy duty, for tub or toilet with or without commode opening   Hdtrans bench w/wo comm open00      960-9                                                                                                 D                          D1E APR    02004010120040101        N                           
E0249001003Pad for water circulating heat unit, for replacement only                       Pad water circulating heat u32      A60-9                                                                                                 D                          D1E APR    01986010120100101        N                           
E0250001003Hospital bed, fixed height, with any type side rails, with mattress             Hosp bed fixed ht w/ mattres36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0251001003Hospital bed, fixed height, with any type side rails, without mattress          Hosp bed fixd ht w/o mattres36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0255001003Hospital bed, variable height, hi-lo, with any type side rails, with mattress   Hospital bed var ht w/ mattr36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0256001003Hospital bed, variable height, hi-lo, with any type side rails, without mattressHospital bed var ht w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0260001003Hospital bed, semi-electric (head and foot adjustment), with any type side      Hosp bed semi-electr w/ matt36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0260002004rails, with mattress                                                                                                                                                                                                                                                                                                 
E0261001003Hospital bed, semi-electric (head and foot adjustment), with any type side      Hosp bed semi-electr w/o mat36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0261002004rails, without mattress                                                                                                                                                                                                                                                                                              
E0265001003Hospital bed, total electric (head, foot and height adjustments), with any type Hosp bed total electr w/ mat36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0265002004side rails, with mattress                                                                                                                                                                                                                                                                                            
E0266001003Hospital bed, total electric (head, foot and height adjustments), with any type Hosp bed total elec w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01986010119910101        N                           
E0266002004side rails, without mattress                                                                                                                                                                                                                                                                                         
E0270001003Hospital bed, institutional type includes: oscillating, circulating and stryker Hospital bed institutional t00      960-9                                                                                                 M                          D1B R      01986010119930101        N                           
E0270002004frame, with mattress                                                                                                                                                                                                                                                                                                 
E0271001003Mattress, innerspring                                                           Mattress innerspring        32      A60-18 60-9                                                                                           D                          D1B APR    01986010119930101        N                           
E0272001003Mattress, foam rubber                                                           Mattress foam rubber        32      A60-18 60-9                                                                                           D                          D1B APR    01986010119930101        N                           
E0273001003Bed board                                                                       Bed board                   00      960-9                                                                                                 M                          D1B APR    01986010119890101        N                           
E0274001003Over-bed table                                                                  Over-bed table              00      960-9                                                                                                 M                          D1B APR    01986010119890101        N                           
E0275001003Bed pan, standard, metal or plastic                                             Bed pan standard            32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0276001003Bed pan, fracture, metal or plastic                                             Bed pan fracture            32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0277001003Powered pressure-reducing air mattress                                          Powered pres-redu air mattrs36      A60-9                                                                                                 D                          D1E R      01992010119980101        N                           
E0280001003Bed cradle, any type                                                            Bed cradle                  32      A                                                                                                     C                          D1B APR    01986010119890101        N                           
E0290001003Hospital bed, fixed height, without side rails, with mattress                   Hosp bed fx ht w/o rails w/m36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0291001003Hospital bed, fixed height, without side rails, without mattress                Hosp bed fx ht w/o rail w/o 36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0292001003Hospital bed, variable height, hi-lo, without side rails, with mattress         Hosp bed var ht no sr w/matt36      A60-18             2100.1                                                                             D                          D1B R      01991010120170101        N                           
E0293001003Hospital bed, variable height, hi-lo, without side rails, without mattress      Hosp bed var ht no sr no mat36      A60-18             2100.1                                                                             D                          D1B R      01991010120170101        N                           
E0294001003Hospital bed, semi-electric (head and foot adjustment), without side rails,     Hosp bed semi-elect w/ mattr36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0294002004with mattress                                                                                                                                                                                                                                                                                                        
E0295001003Hospital bed, semi-electric (head and foot adjustment), without side rails,     Hosp bed semi-elect w/o matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0295002004without mattress                                                                                                                                                                                                                                                                                                     
E0296001003Hospital bed, total electric (head, foot and height adjustments), without side  Hosp bed total elect w/ matt36      A60-18             2100.1                                                                             D                          D1B R      01991010119920101        N                           
E0296002004rails, with mattress                                                                                                                                                                                                                                                                                                 
E0297001003Hospital bed, total electric (head, foot and height adjustments), without side  Hosp bed total elect w/o mat36      A60-18             2100.1                                                                             D                          D1B R      01991010119910101        N                           
E0297002004rails, without mattress                                                                                                                                                                                                                                                                                              
E0300001003Pediatric crib, hospital grade, fully enclosed, with or without top enclosure   Enclosed ped crib hosp grade36      A                                                                                                     C                          D1B APR    02004010120140401        N                           
E0301001003Hospital bed, heavy duty, extra wide, with weight capacity greater than 350     Hd hosp bed, 350-600 lbs    36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0301002004pounds, but less than or equal to 600 pounds, with any type side rails, without                                                                                                                                                                                                                                      
E0301003004mattress                                                                                                                                                                                                                                                                                                             
E0302001003Hospital bed, extra heavy duty, extra wide, with weight capacity greater than   Ex hd hosp bed > 600 lbs    36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0302002004600 pounds, with any type side rails, without mattress                                                                                                                                                                                                                                                               
E0303001003Hospital bed, heavy duty, extra wide, with weight capacity greater than 350     Hosp bed hvy dty xtra wide  36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0303002004pounds, but less than or equal to 600 pounds, with any type side rails, with                                                                                                                                                                                                                                         
E0303003004mattress                                                                                                                                                                                                                                                                                                             
E0304001003Hospital bed, extra heavy duty, extra wide, with weight capacity greater than   Hosp bed xtra hvy dty x wide36      A60-18                                                                                                D                          D1B R      02004010120040101        N                           
E0304002004600 pounds, with any type side rails, with mattress                                                                                                                                                                                                                                                                  
E0305001003Bed side rails, half length                                                     Rails bed side half length  36      A60-18                                                                                                D                          D1B R      01986010119900101        N                           
E0310001003Bed side rails, full length                                                     Rails bed side full length  32      A60-18                                                                                                D                          D1B APR    01986010119900101        N                           
E0315001003Bed accessory: board, table, or support device, any type                        Bed accessory brd/tbl/supprt00      960-9                                                                                                 M                          D1B APR    01986010119970101        N                           
E0316001003Safety enclosure frame/canopy for use with hospital bed, any type               Bed safety enclosure        36      A                                                                                                     C                          D1B APR    02002010120020101        N                           
E0325001003Urinal; male, jug-type, any material                                            Urinal male jug-type        32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0326001003Urinal; female, jug-type, any material                                          Urinal female jug-type      32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0328001003Hospital bed, pediatric, manual, 360 degree side enclosures, top of headboard,  Ped hospital bed, manual    36      A                                                                                                     C                          D1B R      02008010120080101        N                           
E0328002004footboard and side rails up to 24 inches above the spring, includes mattress                                                                                                                                                                                                                                         
E0329001003Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, Ped hospital bed semi/elect 36      A                                                                                                     C                          D1B R      02008010120080101        N                           
E0329002004top of headboard, footboard and side rails up to 24 inches above the spring,                                                                                                                                                                                                                                         
E0329003004includes mattress                                                                                                                                                                                                                                                                                                    
E0350001003Control unit for electronic bowel irrigation/evacuation system                  Control unit bowel system   57      A                                                                                                     C                          Z2  9      01995010119950101        N                           
E0352001003Disposable pack (water reservoir bag, speculum, valving mechanism and           Disposable pack w/bowel syst57      A                                                                                                     C                          Z2  9      01995010119950101        N                           
E0352002004collection bag/box) for use with the electronic bowel irrigation/evacuation                                                                                                                                                                                                                                          
E0352003004system                                                                                                                                                                                                                                                                                                               
E0370001003Air pressure elevator for heel                                                  Air elevator for heel       00      9                                                                                                     C                          D1E APR    01997010119980101        N                           
E0371001003Nonpowered advanced pressure reducing overlay for mattress, standard mattress   Nonpower mattress overlay   36      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0371002004length and width                                                                                                                                                                                                                                                                                                     
E0372001003Powered air overlay for mattress, standard mattress length and width            Powered air mattress overlay36      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0373001003Nonpowered advanced pressure reducing mattress                                  Nonpowered pressure mattress36      A                                                                                                     C                          D1E APR    01998010119980101        N                           
E0424001003Stationary compressed gaseous oxygen system, rental; includes container,        Stationary compressed gas 0233      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N                           
E0424002004contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and                                                                                                                                                                                                                                          
E0424003004tubing                                                                                                                                                                                                                                                                                                               
E0425001003Stationary compressed gas system, purchase; includes regulator, flowmeter,      Gas system stationary compre00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0425002004humidifier, nebulizer, cannula or mask, and tubing                                                                                                                                                                                                                                                                   
E0430001003Portable gaseous oxygen system, purchase; includes regulator, flowmeter,        Oxygen system gas portable  00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0430002004humidifier, cannula or mask, and tubing                                                                                                                                                                                                                                                                              
E0431001003Portable gaseous oxygen system, rental; includes portable container, regulator, Portable gaseous 02         33      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N                           
E0431002004flowmeter, humidifier, cannula or mask, and tubing                                                                                                                                                                                                                                                                   
E0433001003Portable liquid oxygen system, rental; home liquefier used to fill portable     Portable liquid oxygen sys  33      A                                                                                                     C                          D1C APR    02010010120100101        N                           
E0433002004liquid oxygen containers, includes portable containers, regulator, flowmeter,                                                                                                                                                                                                                                        
E0433003004humidifier, cannula or mask and tubing, with or without supply reservoir and                                                                                                                                                                                                                                         
E0433004004contents gauge                                                                                                                                                                                                                                                                                                       
E0434001003Portable liquid oxygen system, rental; includes portable container, supply      Portable liquid 02          33      A60-4              4107.9                                                                             D                          D1C R      01993010119930101        N                           
E0434002004reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or                                                                                                                                                                                                                                         
E0434003004mask, and tubing                                                                                                                                                                                                                                                                                                     
E0435001003Portable liquid oxygen system, purchase; includes portable container, supply    Oxygen system liquid portabl00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0435002004reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and                                                                                                                                                                                                                                        
E0435003004refill adaptor                                                                                                                                                                                                                                                                                                       
E0439001003Stationary liquid oxygen system, rental; includes container, contents,          Stationary liquid 02        33      A60-4              4107.9                                                                             D                          D1C R      01993010120010101        N                           
E0439002004regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing                                                                                                                                                                                                                                               
E0440001003Stationary liquid oxygen system, purchase; includes use of reservoir, contents  Oxygen system liquid station00      960-4              4107.9                                                                             D                          D1C R      01986010119930101        N                           
E0440002004indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and                                                                                                                                                                                                                                         
E0440003004tubing                                                                                                                                                                                                                                                                                                               
E0441001003Stationary oxygen contents, gaseous, 1 month's supply = 1 unit                  Stationary o2 contents, gas 33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N                           
E0442001003Stationary oxygen contents, liquid, 1 month's supply = 1 unit                   Stationary o2 contents, liq 33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N                           
E0443001003Portable oxygen contents, gaseous, 1 month's supply = 1 unit                    Portable 02 contents, gas   33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N                           
E0444001003Portable oxygen contents, liquid, 1 month's supply = 1 unit                     Portable 02 contents, liquid33      A60-4              4107.9                                                                             D                          D1C P      01993010120100101        N                           
E0445001003Oximeter device for measuring blood oxygen levels non-invasively                Oximeter non-invasive       00      9                                                                                                     C                          Z2  9      02003010120030101        N                           
E0446001003Topical oxygen delivery system, not otherwise specified, includes all supplies  Topical ox deliver sys, nos 00      9                                                                                                     C                      0170D1E 9      02011010120171001        N                           
E0446002004and accessories                                                                                                                                                                                                                                                                                                      
E0447001003Portable oxygen contents, liquid, 1 month's supply = 1 unit, prescribed amount  Port o2 cont, liq over 4 lpm33      A60.4              4107.9                                                                             D                          D1C P      02019010120190101        A                           
E0447002004at rest or nighttime exceeds 4 liters per minute (lpm)                                                                                                                                                                                                                                                               
E0450001003Volume control ventilator, without pressure support mode, may include pressure  Vol control vent invasiv int31      A60-9                                                                                                 D                          D1E R      0198501012016010120151231N                           
E0450002004control mode, used with invasive interface (e.g., tracheostomy tube)                                                                                                                                                                                                                                                 
E0455001003Oxygen tent, excluding croup or pediatric tents                                 Oxygen tent excl croup/ped t33      A60-4              4107.9                                                                             D                          D1C R      01986010119900101        N                           
E0457001003Chest shell (cuirass)                                                           Chest shell                 00      9                                                                                                     I                          D1E APR    01990010120140101        N                           
E0459001003Chest wrap                                                                      Chest wrap                  00      9                                                                                                     I                          D1E R      01990010120140101        N                           
E0460001003Negative pressure ventilator; portable or stationary                            Neg press vent portabl/statn31      A60-9                                                                                                 D                          D1E R      0199001012016010120151231N                           
E0461001003Volume control ventilator, without pressure support mode, may include pressure  Vol control vent noninv int 31      A60-9                                                                                                 D                          D1E R      0200301012016010120151231N                           
E0461002004control mode, used with non-invasive interface (e.g., mask)                                                                                                                                                                                                                                                          
E0462001003Rocking bed with or without side rails                                          Rocking bed w/ or w/o side r36      A                                                                                                     C                          D1B R      01990010119960101        N                           
E0463001003Pressure support ventilator with volume control mode, may include pressure      Press supp vent invasive int31      A                                                                                                     C                          D1E R      0200501012016010120151231N                           
E0463002004control mode, used with invasive interface (e.g., tracheostomy tube)                                                                                                                                                                                                                                                 
E0464001003Pressure support ventilator with volume control mode, may include pressure      Press supp vent noninv int  31      A                                                                                                     C                          D1E R      0200501012016010120151231N                           
E0464002004control mode, used with non-invasive interface (e.g., mask)                                                                                                                                                                                                                                                          
E0465001003Home ventilator, any type, used with invasive interface, (e.g., tracheostomy    Home vent invasive interface31      A                  60-9                                                                               D                      0137D1E R      02016010120160101        N                           
E0465002004tube)                                                                                                                                                                                                                                                                                                                
E0466001003Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest Home vent non-invasive inter31      A                  60-9                                                                               D                      0137D1E R      02016010120160101        N                           
E0466002004shell)                                                                                                                                                                                                                                                                                                               
E0467001003Home ventilator, multi-function respiratory device, also performs any or all of Home vent multi-function    31      A60.9                                                                                                 D                      0137D1E R      02019010120190101        A                           
E0467002004the additional functions of oxygen concentration, drug nebulization,                                                                                                                                                                                                                                                 
E0467003004aspiration, and cough stimulation, includes all accessories, components and                                                                                                                                                                                                                                          
E0467004004supplies for all functions                                                                                                                                                                                                                                                                                           
E0470001003Respiratory assist device, bi-level pressure capability, without backup rate    Rad w/o backup non-inv intfc36      A60-9                                                                                                 D                          D1E R      02004010120040101        N                           
E0470002004feature, used with noninvasive interface, e.g., nasal or facial mask                                                                                                                                                                                                                                                 
E0470003004(intermittent assist device with continuous positive airway pressure device)                                                                                                                                                                                                                                         
E0471001003Respiratory assist device, bi-level pressure capability, with back-up rate      Rad w/backup non inv intrfc 36      A60-9                                                                                                 D                          D1E R      02004010120060401        N                           
E0471002004feature, used with noninvasive interface, e.g., nasal or facial mask                                                                                                                                                                                                                                                 
E0471003004(intermittent assist device with continuous positive airway pressure device)                                                                                                                                                                                                                                         
E0472001003Respiratory assist device, bi-level pressure capability, with backup rate       Rad w backup invasive intrfc36      A60-9                                                                                                 D                          D1E R      02004010120060401        N                           
E0472002004feature, used with invasive interface, e.g., tracheostomy tube (intermittent                                                                                                                                                                                                                                         
E0472003004assist device with continuous positive airway pressure device)                                                                                                                                                                                                                                                       
E0480001003Percussor, electric or pneumatic, home model                                    Percussor elect/pneum home m36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0481001003Intrapulmonary percussive ventilation system and related accessories            Intrpulmnry percuss vent sys00      960-21                                                                                                M                          D1E APR    02002010120020701        N                           
E0482001003Cough stimulating device, alternating positive and negative airway pressure     Cough stimulating device    36      A                                                                                                     C                          D1E R      02002010120020101        N                           
E0483001003High frequency chest wall oscillation system, includes all accessories and      Hi freq chest wall oscil sys36      A                                                                                                     C                          D1E R      02003010120190101        C                           
E0483002004supplies, each                                                                                                                                                                                                                                                                                                       
E0484001003Oscillatory positive expiratory pressure device, non-electric, any type, each   Non-elec oscillatory pep dvc32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0485001003Oral device/appliance used to reduce upper airway collapsibility, adjustable or Oral device/appliance prefab32      A                                                                                                     C                          D1E P      02006010120060101        N                           
E0485002004non-adjustable, prefabricated, includes fitting and adjustment                                                                                                                                                                                                                                                       
E0486001003Oral device/appliance used to reduce upper airway collapsibility, adjustable or Oral device/appliance cusfab32      A                                                                                                     C                          D1E P      02006010120060101        N                           
E0486002004non-adjustable, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                   
E0487001003Spirometer, electronic, includes all accessories                                Electronic spirometer       00      9                                                                                                     D                      0156Z2  APR    02009010120090101        N                           
E0500001003Ippb machine, all types, with built-in nebulization; manual or automatic        Ippb all types              31      A60-9                                                                                                 D                          D1E R      01986010119860101        N                           
E0500002004valves; internal or external power source                                                                                                                                                                                                                                                                            
E0550001003Humidifier, durable for extensive supplemental humidification during ippb       Humidif extens supple w ippb33      A60-9                                                                                                 D                          D1E R      01986010120050701        N                           
E0550002004treatments or oxygen delivery                                                                                                                                                                                                                                                                                        
E0555001003Humidifier, durable, glass or autoclavable plastic bottle type, for use with    Humidifier for use w/ regula33      A60-9              4107.9                                                                             D                          D1C PR     01986010119960101        N                           
E0555002004regulator or flowmeter                                                                                                                                                                                                                                                                                               
E0560001003Humidifier, durable for supplemental humidification during ippb treatment or    Humidifier supplemental w/ i33      A60-9                                                                                                 D                          D1E APR    01986010120050701        N                           
E0560002004oxygen delivery                                                                                                                                                                                                                                                                                                      
E0561001003Humidifier, non-heated, used with positive airway pressure device               Humidifier nonheated w pap  32      A                                                                                                     C                          D1E APR    02004010120040101        N                           
E0562001003Humidifier, heated, used with positive airway pressure device                   Humidifier heated used w pap32      A                                                                                                     C                          D1E APR    02004010120040101        N                           
E0565001003Compressor, air power source for equipment which is not self-contained or       Compressor air power source 36      A                                                                                                     C                          D1E R      01982010119820101        N                           
E0565002004cylinder driven                                                                                                                                                                                                                                                                                                      
E0570001003Nebulizer, with compressor                                                      Nebulizer with compression  36      A60-9              4107.9                                                                             D                          D1E R      01986010119960101        N                           
E0572001003Aerosol compressor, adjustable pressure, light duty for intermittent use        Aerosol compressor adjust pr36      A                                                                                                     C                          D1E APR    02001010120010101        N                           
E0574001003Ultrasonic/electronic aerosol generator with small volume nebulizer             Ultrasonic generator w svneb36      A                                                                                                     C                          D1E APR    02001010120030101        N                           
E0575001003Nebulizer, ultrasonic, large volume                                             Nebulizer ultrasonic        36      A60-9                                                                                                 D                          D1E R      01986010120180101        N                           
E0580001003Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with    Nebulizer for use w/ regulat32      A60-9              4107.9                                                                             D                          D1E PR     01986010119980101        N                           
E0580002004regulator or flowmeter                                                                                                                                                                                                                                                                                               
E0585001003Nebulizer, with compressor and heater                                           Nebulizer w/ compressor & he36      A60-9              4107.9                                                                             D                          D1E R      01986010119960101        N                           
E0600001003Respiratory suction pump, home model, portable or stationary, electric          Suction pump portab hom modl36      A60-9                                                                                                 D                          D1E R      01986010120020101        N                           
E0601001003Continuous positive airway pressure (cpap) device                               Cont airway pressure device 36      A60-17                                                                                                D                          D1E R      01988010120140101        N                           
E0602001003Breast pump, manual, any type                                                   Manual breast pump          32      A                                                                                                     C                          D1E 9      02000010120020101        N                           
E0603001003Breast pump, electric (ac and/or dc), any type                                  Electric breast pump        00      9                                                                                                     C                          Z2  9      02002010120020101        N                           
E0604001003Breast pump, hospital grade, electric (ac and / or dc), any type                Hosp grade elec breast pump 00      9                                                                                                     C                          Z2  9      02002010120080101        N                           
E0605001003Vaporizer, room type                                                            Vaporizer room type         32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0606001003Postural drainage board                                                         Drainage board postural     36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0607001003Home blood glucose monitor                                                      Blood glucose monitor home  32      A60-11                                                                                                D                          D1E APR    01986010119960101        N                           
E0610001003Pacemaker monitor, self-contained, (checks battery depletion, includes audible  Pacemaker monitr audible/vis32      A60-7  50-1                                                                                           D                          D1E APR    01986010119960101        N                           
E0610002004and visible check systems)                                                                                                                                                                                                                                                                                           
E0615001003Pacemaker monitor, self contained, checks battery depletion and other pacemaker Pacemaker monitr digital/vis32      A60-7  50-1                                                                                           D                          D1E APR    01986010119960101        N                           
E0615002004components, includes digital/visible check systems                                                                                                                                                                                                                                                                   
E0616001003Implantable cardiac event recorder with memory, activator and programmer        Cardiac event recorder      00      9                                                                                                     C                          D1E 9      02000010120050401        N                           
E0617001003External defibrillator with integrated electrocardiogram analysis               Automatic ext defibrillator 36      A                                                                                                     C                          D1E 9R     02001010120010101        N                           
E0618001003Apnea monitor, without recording feature                                        Apnea monitor               00      9                                                                                                     C                          D1E R      02003010120030101        N                           
E0619001003Apnea monitor, with recording feature                                           Apnea monitor w recorder    00      9                                                                                                     C                          D1E R      02003010120030101        N                           
E0620001003Skin piercing device for collection of capillary blood, laser, each             Cap bld skin piercing laser 36      A                                                                                                     C                          D1E APR    02002010120140401        N                           
E0621001003Sling or seat, patient lift, canvas or nylon                                    Patient lift sling or seat  32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E0625001003Patient lift, bathroom or toilet, not otherwise classified                      Patient lift bathroom or toi00      960-9                                                                                                 M                          D1E APR    01986010120050101        N                           
E0627001003Seat lift mechanism, electric, any type                                         Seat lift mech, electric any32      A60-8              4107.8                                                                             D                          D1E APR    01992010120170101        N                           
E0628001003Separate seat lift mechanism for use with patient owned furniture-electric      Seat lift for pt furn-electr32      A60-8              4107.8                                                                             D                          D1E APR    0199201012017010120161231N                           
E0629001003Seat lift mechanism, non-electric, any type                                     Seat lift mech, non-electric32      A                  4107.8                                                                             D                          D1E APR    01992010120170101        N                           
E0630001003Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or    Patient lift hydraulic      36      A60-9                                                                                                 D                          D1E R      01986010120080101        N                           
E0630002004pad(s)                                                                                                                                                                                                                                                                                                               
E0635001003Patient lift, electric with seat or sling                                       Patient lift electric       36      A60-9                                                                                                 D                          D1E R      01986010119960101        N                           
E0636001003Multipositional patient support system, with integrated lift, patient           Pt support & positioning sys36      A                                                                                                     C                          D1E R      02003010120030101        N                           
E0636002004accessible controls                                                                                                                                                                                                                                                                                                  
E0637001003Combination sit to stand frame/table system, any size including pediatric, with Combination sit to stand sys00      960-9                                                                                                 M                          D1E APR    02004010120120101        N                           
E0637002004seat lift feature, with or without wheels                                                                                                                                                                                                                                                                            
E0638001003Standing frame/table system, one position (e.g., upright, supine or prone       Standing frame sys          00      960-9                                                                                                 M                          D1E APR    02004010120120101        N                           
E0638002004stander), any size including pediatric, with or without wheels                                                                                                                                                                                                                                                       
E0639001003Patient lift, moveable from room to room with disassembly and reassembly,       Moveable patient lift system00      9                                                                                                     C                          Y2  9      02005010120070101        N                           
E0639002004includes all components/accessories                                                                                                                                                                                                                                                                                  
E0640001003Patient lift, fixed system, includes all components/accessories                 Fixed patient lift system   00      9                                                                                                     C                          Y2  9      02005010120070101        N                           
E0641001003Standing frame/table system, multi-position (e.g., three-way stander), any size Multi-position stnd fram sys00      960-9                                                                                                 M                          D1E APR    02006010120120101        N                           
E0641002004including pediatric, with or without wheels                                                                                                                                                                                                                                                                          
E0642001003Standing frame/table system, mobile (dynamic stander), any size including       Dynamic standing frame      00      960-9                                                                                                 M                          D1E APR    02006010120120101        N                           
E0642002004pediatric                                                                                                                                                                                                                                                                                                            
E0650001003Pneumatic compressor, non-segmental home model                                  Pneuma compresor non-segment32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0651001003Pneumatic compressor, segmental home model without calibrated gradient pressure Pneum compressor segmental  32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0652001003Pneumatic compressor, segmental home model with calibrated gradient pressure    Pneum compres w/cal pressure32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0655001003Non-segmental pneumatic appliance for use with pneumatic compressor, half arm   Pneumatic appliance half arm32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0656001003Segmental pneumatic appliance for use with pneumatic compressor, trunk          Segmental pneumatic trunk   36      A                                                                                                     D                      0125D1E APR    02009010120140401        N                           
E0657001003Segmental pneumatic appliance for use with pneumatic compressor, chest          Segmental pneumatic chest   36      A                                                                                                     D                      0125D1E APR    02009010120140401        N                           
E0660001003Non-segmental pneumatic appliance for use with pneumatic compressor, full leg   Pneumatic appliance full leg32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0665001003Non-segmental pneumatic appliance for use with pneumatic compressor, full arm   Pneumatic appliance full arm32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0666001003Non-segmental pneumatic appliance for use with pneumatic compressor, half leg   Pneumatic appliance half leg32      A60-16                                                                                                D                          D1E APR    01986010119960101        N                           
E0667001003Segmental pneumatic appliance for use with pneumatic compressor, full leg       Seg pneumatic appl full leg 32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0668001003Segmental pneumatic appliance for use with pneumatic compressor, full arm       Seg pneumatic appl full arm 32      A60-16                                                                                                D                          D1E APR    01988010119960101        N                           
E0669001003Segmental pneumatic appliance for use with pneumatic compressor, half leg       Seg pneumatic appli half leg32      A60-16                                                                                                D                          D1E APR    01994010119940101        N                           
E0670001003Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2  Seg pneum int legs/trunk    32      A60-16                                                                                                D                          D1E APR    02013010120130101        N                           
E0670002004full legs and trunk                                                                                                                                                                                                                                                                                                  
E0671001003Segmental gradient pressure pneumatic appliance, full leg                       Pressure pneum appl full leg32      A60-16                                                                                                D                          D1E APR    01995010119950101        N                           
E0672001003Segmental gradient pressure pneumatic appliance, full arm                       Pressure pneum appl full arm32      A60-16                                                                                                D                          D1E APR    01995010119950101        N                           
E0673001003Segmental gradient pressure pneumatic appliance, half leg                       Pressure pneum appl half leg32      A60-16                                                                                                D                          D1E APR    01995010119950101        N                           
E0675001003Pneumatic compression device, high pressure, rapid inflation/deflation cycle,   Pneumatic compression device36      A                                                                                                     C                          D1E R      02004010120040101        N                           
E0675002004for arterial insufficiency (unilateral or bilateral system)                                                                                                                                                                                                                                                          
E0676001003Intermittent limb compression device (includes all accessories), not otherwise  Inter limb compress dev nos 00      9                                                                                                     C                          D1E APR    02007010120070101        N                           
E0676002004specified                                                                                                                                                                                                                                                                                                            
E0691001003Ultraviolet light therapy system, includes bulbs/lamps, timer and eye           Uvl pnl 2 sq ft or less     32      A                                                                                                     C                          D1E APR    02003010120120101        N                           
E0691002004protection; treatment area 2 square feet or less                                                                                                                                                                                                                                                                     
E0692001003Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye     Uvl sys panel 4 ft          32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0692002004protection, 4 foot panel                                                                                                                                                                                                                                                                                             
E0693001003Ultraviolet light therapy system panel, includes bulbs/lamps, timer and eye     Uvl sys panel 6 ft          32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0693002004protection, 6 foot panel                                                                                                                                                                                                                                                                                             
E0694001003Ultraviolet multidirectional light therapy system in 6 foot cabinet, includes   Uvl md cabinet sys 6 ft     32      A                                                                                                     C                          D1E APR    02003010120030101        N                           
E0694002004bulbs/lamps, timer and eye protection                                                                                                                                                                                                                                                                                
E0700001003Safety equipment, device or accessory, any type                                 Safety equipment            00      9                                                                                                     C                          D1E APR    01986010120100101        N                           
E0705001003Transfer device, any type, each                                                 Transfer device             32      A                                                                                                     D                      0125D1E APR    02006010120080101        N                           
E0710001003Restraints, any type (body, chest, wrist or ankle)                              Restraints any type         57      A                                                                                                     C                          Z2  APR    01986010119960101        N                           
E0720001003Transcutaneous electrical nerve stimulation (tens) device, two lead, localized  Tens two lead               32      A35-20 35-46       4107.6                                                                             D                          D1E APR    01986010120070101        N                           
E0720002004stimulation                                                                                                                                                                                                                                                                                                          
E0730001003Transcutaneous electrical nerve stimulation (tens) device, four or more leads,  Tens four lead              32      A35-20 35-46       4107.6                                                                             D                          D1E APR    01986010120070101        N                           
E0730002004for multiple nerve stimulation                                                                                                                                                                                                                                                                                       
E0731001003Form fitting conductive garment for delivery of tens or nmes (with conductive   Conductive garment for tens/34      A45-25                                                                                                D                          D1E APR    01989010119960101        N                           
E0731002004fibers separated from the patient's skin by layers of fabric)                                                                                                                                                                                                                                                        
E0740001003Non-implanted pelvic floor electrical stimulator, complete system               Non-implant pelv flr e-stim 36      A60.24                                                                                                D                          D1E APR    01986010120170101        N                           
E0744001003Neuromuscular stimulator for scoliosis                                          Neuromuscular stim for scoli36      A                                                                                                     C                          D1E R      01989010119960101        N                           
E0745001003Neuromuscular stimulator, electronic shock unit                                 Neuromuscular stim for shock36      A35-77                                                                                                D                          D1E R      01986010119960101        N                           
E0746001003Electromyography (emg), biofeedback device                                      Electromyograph biofeedback 52      A35-27                                                                                                D                          D1E APR    01989010119960101        N                           
E0747001003Osteogenesis stimulator, electrical, non-invasive, other than spinal            Elec osteogen stim not spine32      A35-48                                                                                                D                          D1E APR    01986010119970101        N                           
E0747002004applications                                                                                                                                                                                                                                                                                                         
E0748001003Osteogenesis stimulator, electrical, non-invasive, spinal applications          Elec osteogen stim spinal   32      A35-48                                                                                                D                          D1E APR    01996010119970101        N                           
E0749001003Osteogenesis stimulator, electrical, surgically implanted                       Elec osteogen stim implanted36      A35-48                                                                                                D                          D1E 9      01986010120000701        N                           
E0755001003Electronic salivary reflex stimulator (intra-oral/non-invasive)                 Electronic salivary reflex s52      A                                                                                                     C                          Z2  APR    01990010119950401        N                           
E0760001003Osteogenesis stimulator, low intensity ultrasound, non-invasive                 Osteogen ultrasound stimltor32      A                  35-48                                                                              C                          D1E APR    01997010120010101        N                           
E0761001003Non-thermal pulsed high frequency radiowaves, high peak power electromagnetic   Nontherm electromgntc device00      935-102                                                                                               D                          D1E 9      02003010120050101        N                           
E0761002004energy treatment device                                                                                                                                                                                                                                                                                              
E0762001003Transcutaneous electrical joint stimulation device system, includes all         Trans elec jt stim dev sys  36      A                                                                                                     C                          D1E APR    02006010120060101        N                           
E0762002004accessories                                                                                                                                                                                                                                                                                                          
E0764001003Functional neuromuscular stimulation, transcutaneous stimulation of sequential  Functional neuromuscularstim36      A35-77                                                                                                D                          D1F APR    02006010120140401        N                           
E0764002004muscle groups of ambulation with computer control, used for walking by spinal                                                                                                                                                                                                                                        
E0764003004cord injured, entire system, after completion of training program                                                                                                                                                                                                                                                    
E0765001003Fda approved nerve stimulator, with replaceable batteries, for treatment of     Nerve stimulator for tx n&v 32      A                                                                                                     C                          D1E APR    02001010120100101        N                           
E0765002004nausea and vomiting                                                                                                                                                                                                                                                                                                  
E0766001003Electrical stimulation device used for cancer treatment, includes all           Elec stim cancer treatment  31      A                                                                                                     C                          D1E R      02014010120140101        N                           
E0766002004accessories, any type                                                                                                                                                                                                                                                                                                
E0769001003Electrical stimulation or electromagnetic wound treatment device, not otherwise Electric wound treatment dev00      935-102                                                                                               D                          Y2  9      02005010120050101        N                           
E0769002004classified                                                                                                                                                                                                                                                                                                           
E0770001003Functional electrical stimulator, transcutaneous stimulation of nerve and/or    Functional electric stim nos46      A                                                                                                     D                      0152D1E APR    02009010120090101        N                           
E0770002004muscle groups, any type, complete system, not otherwise specified                                                                                                                                                                                                                                                    
E0776001003Iv pole                                                                         Iv pole                     32      A                                                                                                     C                          D1E AEP    01985010119960101        N                           
E0779001003Ambulatory infusion pump, mechanical, reusable, for infusion 8 hours or greater Amb infusion pump mechanical36      A                                                                                                     C                          D1E APR    02000010120000101        N                           
E0780001003Ambulatory infusion pump, mechanical, reusable, for infusion less than 8 hours  Mech amb infusion pump <8hrs32      A                                                                                                     C                          D1E APR    02000010120000101        N                           
E0781001003Ambulatory infusion pump, single or multiple channels, electric or battery      External ambulatory infus pu36      A60-14                                                                                                D                          D1E 9R     01987010120000701        N                           
E0781002004operated, with administrative equipment, worn by patient                                                                                                                                                                                                                                                             
E0782001003Infusion pump, implantable, non-programmable (includes all components, e.g.,    Non-programble infusion pump32      A60-14                                                                                                D                          D1E APR    01986010120030101        N                           
E0782002004pump, catheter, connectors, etc.)                                                                                                                                                                                                                                                                                    
E0783001003Infusion pump system, implantable, programmable (includes all components, e.g., Programmable infusion pump  32      A60-14                                                                                                D                          D1E APR    01995010119980101        N                           
E0783002004pump, catheter, connectors, etc.)                                                                                                                                                                                                                                                                                    
E0784001003External ambulatory infusion pump, insulin                                      Ext amb infusn pump insulin 36      A60-14                                                                                                D                          D1E R      01996010120000701        N                           
E0785001003Implantable intraspinal (epidural/intrathecal) catheter used with implantable   Replacement impl pump cathet32      A                  60-14                                                                              D                          D1E P      01999010119990101        N                           
E0785002004infusion pump, replacement                                                                                                                                                                                                                                                                                           
E0786001003Implantable programmable infusion pump, replacement (excludes implantable       Implantable pump replacement32      A60-14                                                                                                D                          D1E 9      02001010120010101        N                           
E0786002004intraspinal catheter)                                                                                                                                                                                                                                                                                                
E0791001003Parenteral infusion pump, stationary, single or multi-channel                   Parenteral infusion pump sta36      A65-10             2130    4450                                                                       D                          D1E R      01989010119960101        N                           
E0830001003Ambulatory traction device, all types, each                                     Ambulatory traction device  00      960-9                                                                                                 D                          D1E P      02001010120010101        N                           
E0840001003Traction frame, attached to headboard, cervical traction                        Tract frame attach headboard32      A60-9                                                                                                 D                          D1E APR    01984010119940101        N                           
E0849001003Traction equipment, cervical, free-standing stand/frame, pneumatic, applying    Cervical pneum trac equip   36      A                                                                                                     C                          D1E APR    02005010120140401        N                           
E0849002004traction force to other than mandible                                                                                                                                                                                                                                                                                
E0850001003Traction stand, free standing, cervical traction                                Traction stand free standing32      A60-9                                                                                                 D                          D1E APR    01982010119940101        N                           
E0855001003Cervical traction equipment not requiring additional stand or frame             Cervical traction equipment 36      A                                                                                                     C                          D1E APR    01998010120140401        N                           
E0856001003Cervical traction device, with inflatable air bladder(s)                        Cervic collar w air bladders36      A                                                                                                     C                          D1E APR    02008010120150101        N                           
E0860001003Traction equipment, overdoor, cervical                                          Tract equip cervical tract  32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N                           
E0870001003Traction frame, attached to footboard, extremity traction, (e.g., buck's)       Tract frame attach footboard32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0880001003Traction stand, free standing, extremity traction, (e.g., buck's)               Trac stand free stand extrem32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0890001003Traction frame, attached to footboard, pelvic traction                          Traction frame attach pelvic32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0900001003Traction stand, free standing, pelvic traction, (e.g., buck's)                  Trac stand free stand pelvic32      A60-9                                                                                                 D                          D1E APR    01986010119940101        N                           
E0910001003Trapeze bars, a/k/a patient helper, attached to bed, with grab bar              Trapeze bar attached to bed 36      A60-9                                                                                                 D                          D1E R      01986010119840101        N                           
E0911001003Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds,   Hd trapeze bar attach to bed36      A60-9                                                                                                 D                          D1B R      02006010120060101        N                           
E0911002004attached to bed, with grab bar                                                                                                                                                                                                                                                                                       
E0912001003Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds,   Hd trapeze bar free standing36      A60-9                                                                                                 D                          D1B R      02006010120060101        N                           
E0912002004free standing, complete with grab bar                                                                                                                                                                                                                                                                                
E0920001003Fracture frame, attached to bed, includes weights                               Fracture frame attached to b36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0930001003Fracture frame, free standing, includes weights                                 Fracture frame free standing36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0935001003Continuous passive motion exercise device for use on knee only                  Cont pas motion exercise dev31      A60-9                                                                                                 D                          D1E R      01986010120060101        N                           
E0936001003Continuous passive motion exercise device for use other than knee               Cpm device, other than knee 00      9                                                                                                     M                      0137D1E R      02007010120070101        N                           
E0940001003Trapeze bar, free standing, complete with grab bar                              Trapeze bar free standing   36      A60-9                                                                                                 D                          D1B R      01986010119890101        N                           
E0941001003Gravity assisted traction device, any type                                      Gravity assisted traction de36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0942001003Cervical head harness/halter                                                    Cervical head harness/halter32      A                                                                                                     C                          D1E APR    01986010119860101        N                           
E0944001003Pelvic belt/harness/boot                                                        Pelvic belt/harness/boot    32      A                                                                                                     C                          D1E APR    01985010119960101        N                           
E0945001003Extremity belt/harness                                                          Belt/harness extremity      32      A                                                                                                     C                          D1E APR    01985010119960101        N                           
E0946001003Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)Fracture frame dual w cross 36      A60-9                                                                                                 D                          D1E R      01986010119890101        N                           
E0947001003Fracture frame, attachments for complex pelvic traction                         Fracture frame attachmnts pe32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N                           
E0948001003Fracture frame, attachments for complex cervical traction                       Fracture frame attachmnts ce32      A60-9                                                                                                 D                          D1E APR    01986010119890101        N                           
E0950001003Wheelchair accessory, tray, each                                                Tray                        32      A60-9                                                                                                 D                          D1D APR    01986010120180101        N                           
E0951001003Heel loop/holder, any type, with or without ankle strap, each                   Loop heel                   00      9                                                                                                     C                          D1D APR    01986010120050101        N                           
E0952001003Toe loop/holder, any type, each                                                 Toe loop/holder, each       00      960-9                                                                                                 D                          D1D APR    01986010120050101        N                           
E0953001003Wheelchair accessory, lateral thigh or knee support, any type including fixed   W/c lateral thigh/knee sup  32      A                                                                                                     C                          D1D APR    02018010120180101        N                           
E0953002004mounting hardware, each                                                                                                                                                                                                                                                                                              
E0954001003Wheelchair accessory, foot box, any type, includes attachment and mounting      Foot box, any type each foot32      A                                                                                                     C                          D1D APR    02018010120180101        N                           
E0954002004hardware, each foot                                                                                                                                                                                                                                                                                                  
E0955001003Wheelchair accessory, headrest, cushioned, any type, including fixed mounting   Cushioned headrest          36      A                                                                                                     C                          D1D APR    02004010120160701        N                           
E0955002004hardware, each                                                                                                                                                                                                                                                                                                       
E0956001003Wheelchair accessory, lateral trunk or hip support, any type, including fixed   W/c lateral trunk/hip suppor32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E0956002004mounting hardware, each                                                                                                                                                                                                                                                                                              
E0957001003Wheelchair accessory, medial thigh support, any type, including fixed mounting  W/c medial thigh support    32      A                                                                                                     C                          D1D APR    02004010120050101        N                           
E0957002004hardware, each                                                                                                                                                                                                                                                                                                       
E0958001003Manual wheelchair accessory, one-arm drive attachment, each                     Whlchr att- conv 1 arm drive00      960-9                                                                                                 D                          D1D R      01986010120040101        N                           
E0959001003Manual wheelchair accessory, adapter for amputee, each                          Amputee adapter             00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0960001003Wheelchair accessory, shoulder harness/straps or chest strap, including any     W/c shoulder harness/straps 32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0960002004type mounting hardware                                                                                                                                                                                                                                                                                               
E0961001003Manual wheelchair accessory, wheel lock brake extension (handle), each          Wheelchair brake extension  00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0966001003Manual wheelchair accessory, headrest extension, each                           Wheelchair head rest extensi00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0967001003Manual wheelchair accessory, hand rim with projections, any type, replacement   Man wc rim/projection rep ea32      A60-9                                                                                                 D                          D1D APR    01986010120170101        N                           
E0967002004only, each                                                                                                                                                                                                                                                                                                           
E0968001003Commode seat, wheelchair                                                        Wheelchair commode seat     36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E0969001003Narrowing device, wheelchair                                                    Wheelchair narrowing device 32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E0970001003No. 2 footplates, except for elevating leg rest                                 Wheelchair no. 2 footplates 00      960-9                                                                        K0037K0042               I                          D1D APR    01986010120010401        N                           
E0971001003Manual wheelchair accessory, anti-tipping device, each                          Wheelchair anti-tipping devi00      960-9                                                                        K0021                    C                          D1D APR    01986010120060101        N                           
E0973001003Wheelchair accessory, adjustable height, detachable armrest, complete assembly, W/ch access det adj armrest 00      960-9                                                                                                 D                          D1D APR    01986010120040101        N                           
E0973002004each                                                                                                                                                                                                                                                                                                                 
E0974001003Manual wheelchair accessory, anti-rollback device, each                         W/ch access anti-rollback   00      960-9                                                                                                 D                          D1D APR    01986010120040101        N                           
E0978001003Wheelchair accessory, positioning belt/safety belt/pelvic strap, each           W/c acc,saf belt pelv strap 32      A                                                                                                     C                          D1D APR    01986010120050101        N                           
E0980001003Safety vest, wheelchair                                                         Wheelchair safety vest      32      A                                                                                                     C                          D1D APR    01986010119890101        N                           
E0981001003Wheelchair accessory, seat upholstery, replacement only, each                   Seat upholstery, replacement32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0982001003Wheelchair accessory, back upholstery, replacement only, each                   Back upholstery, replacement32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E0983001003Manual wheelchair accessory, power add-on to convert manual wheelchair to       Add pwr joystick            36      A                                                                                                     C                          D1D R      02004010120040101        N                           
E0983002004motorized wheelchair, joystick control                                                                                                                                                                                                                                                                               
E0984001003Manual wheelchair accessory, power add-on to convert manual wheelchair to       Add pwr tiller              36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E0984002004motorized wheelchair, tiller control                                                                                                                                                                                                                                                                                 
E0985001003Wheelchair accessory, seat lift mechanism                                       W/c seat lift mechanism     36      A                                                                                                     C                          D1D APR    02004010120160701        N                           
E0986001003Manual wheelchair accessory, push-rim activated power assist system             Man w/c push-rim powr system36      A                                                                                                     C                          D1D APR    02004010120150101        N                           
E0988001003Manual wheelchair accessory, lever-activated, wheel drive, pair                 Lever-activated wheel drive 36      A                                                                                                     C                          D1D R      02012010120120101        N                           
E0990001003Wheelchair accessory, elevating leg rest, complete assembly, each               Wheelchair elevating leg res00      960-9                                                                                                 C                          D1D APR    01986010120040101        N                           
E0992001003Manual wheelchair accessory, solid seat insert                                  Wheelchair solid seat insert32      A                                                                                                     C                          D1D APR    01986010120040101        N                           
E0994001003Arm rest, each                                                                  Wheelchair arm rest         32      A60-9                                                                                                 D                          D1D APR    01986010119890101        N                           
E0995001003Wheelchair accessory, calf rest/pad, replacement only, each                     Wc calf rest, pad replacemnt00      960-9                                                                                                 C                          D1D APR    01986010120170101        N                           
E1002001003Wheelchair accessory, power seating system, tilt only                           Pwr seat tilt               36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1003001003Wheelchair accessory, power seating system, recline only, without shear         Pwr seat recline            36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1003002004reduction                                                                                                                                                                                                                                                                                                            
E1004001003Wheelchair accessory, power seating system, recline only, with mechanical shear Pwr seat recline mech       36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1004002004reduction                                                                                                                                                                                                                                                                                                            
E1005001003Wheelchair accessory, power seatng system, recline only, with power shear       Pwr seat recline pwr        36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1005002004reduction                                                                                                                                                                                                                                                                                                            
E1006001003Wheelchair accessory, power seating system, combination tilt and recline,       Pwr seat combo w/o shear    36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1006002004without shear reduction                                                                                                                                                                                                                                                                                              
E1007001003Wheelchair accessory, power seating system, combination tilt and recline, with  Pwr seat combo w/shear      36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1007002004mechanical shear reduction                                                                                                                                                                                                                                                                                           
E1008001003Wheelchair accessory, power seating system, combination tilt and recline, with  Pwr seat combo pwr shear    36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1008002004power shear reduction                                                                                                                                                                                                                                                                                                
E1009001003Wheelchair accessory, addition to power seating system, mechanically linked leg Add mech leg elevation      32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E1009002004elevation system, including pushrod and leg rest, each                                                                                                                                                                                                                                                               
E1010001003Wheelchair accessory, addition to power seating system, power leg elevation     Add pwr leg elevation       36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1010002004system, including leg rest, pair                                                                                                                                                                                                                                                                                     
E1011001003Modification to pediatric size wheelchair, width adjustment package (not to be  Ped wc modify width adjustm 32      A60-9                                                                                                 D                          D1D APR    02003010120050101        N                           
E1011002004dispensed with initial chair)                                                                                                                                                                                                                                                                                        
E1012001003Wheelchair accessory, addition to power seating system, center mount power      Ctr mount pwr elev leg rest 36      A                                                                                                     C                          D1D APR    02016010120160101        N                           
E1012002004elevating leg rest/platform, complete system, any type, each                                                                                                                                                                                                                                                         
E1014001003Reclining back, addition to pediatric size wheelchair                           Reclining back add ped w/c  36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1015001003Shock absorber for manual wheelchair, each                                      Shock absorber for man w/c  32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1016001003Shock absorber for power wheelchair, each                                       Shock absorber for power w/c32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1017001003Heavy duty shock absorber for heavy duty or extra heavy duty manual wheelchair, Hd shck absrbr for hd man wc32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1017002004each                                                                                                                                                                                                                                                                                                                 
E1018001003Heavy duty shock absorber for heavy duty or extra heavy duty power wheelchair,  Hd shck absrber for hd powwc32      A                  60.9                                                                               D                          D1D APR    02003010120030101        N                           
E1018002004each                                                                                                                                                                                                                                                                                                                 
E1020001003Residual limb support system for wheelchair, any type                           Residual limb support system36      A                  60-6                                                                               D                          D1D APR    02003010120160701        N                           
E1028001003Wheelchair accessory, manual swingaway, retractable or removable mounting       W/c manual swingaway        36      A                                                                                                     C                          D1D APR    02004010120160701        N                           
E1028002004hardware for joystick, other control interface or positioning accessory                                                                                                                                                                                                                                              
E1029001003Wheelchair accessory, ventilator tray, fixed                                    W/c vent tray fixed         36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1030001003Wheelchair accessory, ventilator tray, gimbaled                                 W/c vent tray gimbaled      36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E1031001003Rollabout chair, any and all types with casters 5" or greater                   Rollabout chair with casters36      A60-9                                                                                                 D                          D1D R      01990010119900101        N                           
E1035001003Multi-positional patient transfer system, with integrated seat, operated by     Patient transfer system <30036      A                  2100                                                                               D                          D1D R      02001010120100101        N                           
E1035002004care giver, patient weight capacity up to and including 300 lbs                                                                                                                                                                                                                                                      
E1036001003Multi-positional patient transfer system, extra-wide, with integrated seat,     Patient transfer system >30036      A                                                                                                     C                          D1D R      02010010120100101        N                           
E1036002004operated by caregiver, patient weight capacity greater than 300 lbs                                                                                                                                                                                                                                                  
E1037001003Transport chair, pediatric size                                                 Transport chair, ped size   36      A60-9                                                                                                 D                          D1D R      02003010120030101        N                           
E1038001003Transport chair, adult size, patient weight capacity up to and including 300    Transport chair pt wt<=300lb36      A60-9                                                                                                 D                          D1D R      02003010120060101        N                           
E1038002004pounds                                                                                                                                                                                                                                                                                                               
E1039001003Transport chair, adult size, heavy duty, patient weight capacity greater than   Transport chair pt wt >300lb36      A                                                                                                     C                          D1D R      02005010120060101        N                           
E1039002004300 pounds                                                                                                                                                                                                                                                                                                           
E1050001003Fully-reclining wheelchair, fixed full length arms, swing away detachable       Whelchr fxd full length arms36      A60-9                                                                                                 D                          D1D R      01986010119840101        N                           
E1050002004elevating leg rests                                                                                                                                                                                                                                                                                                  
E1060001003Fully-reclining wheelchair, detachable arms, desk or full length, swing away    Wheelchair detachable arms  36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1060002004detachable elevating legrests                                                                                                                                                                                                                                                                                        
E1070001003Fully-reclining wheelchair, detachable arms (desk or full length) swing away    Wheelchair detachable foot r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1070002004detachable footrest                                                                                                                                                                                                                                                                                                  
E1083001003Hemi-wheelchair, fixed full length arms, swing away detachable elevating leg    Hemi-wheelchair fixed arms  36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1083002004rest                                                                                                                                                                                                                                                                                                                 
E1084001003Hemi-wheelchair, detachable arms desk or full length arms, swing away           Hemi-wheelchair detachable a36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1084002004detachable elevating leg rests                                                                                                                                                                                                                                                                                       
E1085001003Hemi-wheelchair, fixed full length arms, swing away detachable foot rests       Hemi-wheelchair fixed arms  00      960-9                                                                        K0002                    I                          D1D R      01986010120010401        N                           
E1086001003Hemi-wheelchair detachable arms desk or full length, swing away detachable      Hemi-wheelchair detachable a00      960-9                                                                        K0002                    I                          D1D R      01986010120010401        N                           
E1086002004footrests                                                                                                                                                                                                                                                                                                            
E1087001003High strength lightweight wheelchair, fixed full length arms, swing away        Wheelchair lightwt fixed arm36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1087002004detachable elevating leg rests                                                                                                                                                                                                                                                                                       
E1088001003High strength lightweight wheelchair, detachable arms desk or full length,      Wheelchair lightweight det a36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1088002004swing away detachable elevating leg rests                                                                                                                                                                                                                                                                            
E1089001003High strength lightweight wheelchair, fixed length arms, swing away detachable  Wheelchair lightwt fixed arm00      960-9                                                                        K0004                    I                          D1D R      01986010120010401        N                           
E1089002004footrest                                                                                                                                                                                                                                                                                                             
E1090001003High strength lightweight wheelchair, detachable arms desk or full length,      Wheelchair lightweight det a00      960-9                                                                        K0004                    I                          D1D R      01986010120010401        N                           
E1090002004swing away detachable foot rests                                                                                                                                                                                                                                                                                     
E1092001003Wide heavy duty wheel chair, detachable arms (desk or full length), swing away  Wheelchair wide w/ leg rests36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1092002004detachable elevating leg rests                                                                                                                                                                                                                                                                                       
E1093001003Wide heavy duty wheelchair, detachable arms desk or full length arms, swing     Wheelchair wide w/ foot rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1093002004away detachable footrests                                                                                                                                                                                                                                                                                            
E1100001003Semi-reclining wheelchair, fixed full length arms, swing away detachable        Whchr s-recl fxd arm leg res36      A60-9                                                                                                 D                          D1D R      01986010119880101        N                           
E1100002004elevating leg rests                                                                                                                                                                                                                                                                                                  
E1110001003Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg  Wheelchair semi-recl detach 36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1110002004rest                                                                                                                                                                                                                                                                                                                 
E1130001003Standard wheelchair, fixed full length arms, fixed or swing away detachable     Whlchr stand fxd arm ft rest00      960-9                                                                        K0001                    I                          D1D R      01986010120010401        N                           
E1130002004footrests                                                                                                                                                                                                                                                                                                            
E1140001003Wheelchair, detachable arms, desk or full length, swing away detachable         Wheelchair standard detach a00      960-9                                                                        K0001                    I                          D1D R      01986010120010401        N                           
E1140002004footrests                                                                                                                                                                                                                                                                                                            
E1150001003Wheelchair, detachable arms, desk or full length swing away detachable          Wheelchair standard w/ leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1150002004elevating legrests                                                                                                                                                                                                                                                                                                   
E1160001003Wheelchair, fixed full length arms, swing away detachable elevating legrests    Wheelchair fixed arms       36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1161001003Manual adult size wheelchair, includes tilt in space                            Manual adult wc w tiltinspac36      A                                                                                                     C                          D1D APR    02003010120140401        N                           
E1170001003Amputee wheelchair, fixed full length arms, swing away detachable elevating     Whlchr ampu fxd arm leg rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1170002004legrests                                                                                                                                                                                                                                                                                                             
E1171001003Amputee wheelchair, fixed full length arms, without footrests or legrest        Wheelchair amputee w/o leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1172001003Amputee wheelchair, detachable arms (desk or full length) without footrests or  Wheelchair amputee detach ar36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1172002004legrest                                                                                                                                                                                                                                                                                                              
E1180001003Amputee wheelchair, detachable arms (desk or full length) swing away detachable Wheelchair amputee w/ foot r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1180002004footrests                                                                                                                                                                                                                                                                                                            
E1190001003Amputee wheelchair, detachable arms (desk or full length) swing away detachable Wheelchair amputee w/ leg re36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1190002004elevating legrests                                                                                                                                                                                                                                                                                                   
E1195001003Heavy duty wheelchair, fixed full length arms, swing away detachable elevating  Wheelchair amputee heavy dut36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1195002004legrests                                                                                                                                                                                                                                                                                                             
E1200001003Amputee wheelchair, fixed full length arms, swing away detachable footrest      Wheelchair amputee fixed arm36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1220001003Wheelchair; specially sized or constructed, (indicate brand name, model number, Whlchr special size/constrc 45      A60-6                                                                                                 D                          D1D P      01986010119900101        N                           
E1220002004if any) and justification                                                                                                                                                                                                                                                                                            
E1221001003Wheelchair with fixed arm, footrests                                            Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1222001003Wheelchair with fixed arm, elevating legrests                                   Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1223001003Wheelchair with detachable arms, footrests                                      Wheelchair spec size w foot 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1224001003Wheelchair with detachable arms, elevating legrests                             Wheelchair spec size w/ leg 36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1225001003Wheelchair accessory, manual semi-reclining back, (recline greater than 15      Manual semi-reclining back  36      A60-6                                                                                                 D                          D1D R      01986010120050101        N                           
E1225002004degrees, but less than 80 degrees), each                                                                                                                                                                                                                                                                             
E1226001003Wheelchair accessory, manual fully reclining back, (recline greater than 80     Manual fully reclining back 00      960-9                                                                                                 D                          D1D APR    01986010120050101        N                           
E1226002004degrees), each                                                                                                                                                                                                                                                                                                       
E1227001003Special height arms for wheelchair                                              Wheelchair spec sz spec ht a32      A60-6                                                                                                 D                          D1D APR    01986010119900101        N                           
E1228001003Special back height for wheelchair                                              Wheelchair spec sz spec ht b36      A60-6                                                                                                 D                          D1D R      01986010119900101        N                           
E1229001003Wheelchair, pediatric size, not otherwise specified                             Pediatric wheelchair nos    32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E1230001003Power operated vehicle (three or four wheel nonhighway) specify brand name and  Power operated vehicle      32      A60-5              4107.6                                                                             D                          D1D APR    01986010119910101        N                           
E1230002004model number                                                                                                                                                                                                                                                                                                         
E1231001003Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, with seating      Rigid ped w/c tilt-in-space 32      A60-9                                                                                                 D                          D1D APR    02003010120090101        N                           
E1231002004system                                                                                                                                                                                                                                                                                                               
E1232001003Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating    Folding ped wc tilt-in-space36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1232002004system                                                                                                                                                                                                                                                                                                               
E1233001003Wheelchair, pediatric size, tilt-in-space, rigid, adjustable, without seating   Rig ped wc tltnspc w/o seat 36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1233002004system                                                                                                                                                                                                                                                                                                               
E1234001003Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating Fld ped wc tltnspc w/o seat 36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1234002004system                                                                                                                                                                                                                                                                                                               
E1235001003Wheelchair, pediatric size, rigid, adjustable, with seating system              Rigid ped wc adjustable     36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1236001003Wheelchair, pediatric size, folding, adjustable, with seating system            Folding ped wc adjustable   36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1237001003Wheelchair, pediatric size, rigid, adjustable, without seating system           Rgd ped wc adjstabl w/o seat36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1238001003Wheelchair, pediatric size, folding, adjustable, without seating system         Fld ped wc adjstabl w/o seat36      A60-9                                                                                                 D                          D1D APR    02003010120140401        N                           
E1239001003Power wheelchair, pediatric size, not otherwise specified                       Ped power wheelchair nos    36      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E1240001003Lightweight wheelchair, detachable arms, (desk or full length) swing away       Whchr litwt det arm leg rest36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1240002004detachable, elevating legrest                                                                                                                                                                                                                                                                                        
E1250001003Lightweight wheelchair, fixed full length arms, swing away detachable footrest  Wheelchair lightwt fixed arm00      960-9                                                                        K0003                    I                          D1D R      01986010120010401        N                           
E1260001003Lightweight wheelchair, detachable arms (desk or full length) swing away        Wheelchair lightwt foot rest00      960-9                                                                        K0003                    I                          D1D R      01986010120010401        N                           
E1260002004detachable footrest                                                                                                                                                                                                                                                                                                  
E1270001003Lightweight wheelchair, fixed full length arms, swing away detachable elevating Wheelchair lightweight leg r36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1270002004legrests                                                                                                                                                                                                                                                                                                             
E1280001003Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests Whchr h-duty det arm leg res36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1285001003Heavy duty wheelchair, fixed full length arms, swing away detachable footrest   Wheelchair heavy duty fixed 00      960-9                                                                        K0006                    I                          D1D R      01986010120010401        N                           
E1290001003Heavy duty wheelchair, detachable arms (desk or full length) swing away         Wheelchair hvy duty detach a00      960-9                                                                        K0006                    I                          D1D R      01986010120010401        N                           
E1290002004detachable footrest                                                                                                                                                                                                                                                                                                  
E1295001003Heavy duty wheelchair, fixed full length arms, elevating legrest                Wheelchair heavy duty fixed 36      A60-9                                                                                                 D                          D1D R      01986010119890101        N                           
E1296001003Special wheelchair seat height from floor                                       Wheelchair special seat heig32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N                           
E1297001003Special wheelchair seat depth, by upholstery                                    Wheelchair special seat dept32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N                           
E1298001003Special wheelchair seat depth and/or width, by construction                     Wheelchair spec seat depth/w32      A60-6                                                                                                 D                          D1D APR    01986010119890101        N                           
E1300001003Whirlpool, portable (overtub type)                                              Whirlpool portable          00      960-9                                                                                                 M                          D1E APR    01986010119960101        N                           
E1310001003Whirlpool, non-portable (built-in type)                                         Whirlpool non-portable      32      A60-9                                                                                                 D                          D1E APR    01986010119960101        N                           
E1352001003Oxygen accessory, flow regulator capable of positive inspiratory pressure       O2 flow reg pos inspir press00      9                                                                                                     C                          D1C P      02014010120140101        N                           
E1353001003Regulator                                                                       Oxygen supplies regulator   00      960-4              4107.9                                                                             D                          D1C R      01986010120090101        N                           
E1354001003Oxygen accessory, wheeled cart for portable cylinder or portable concentrator,  Wheeled cart, port cyl/conc 00      9                                                                                                     C                          D1C APR    02009010120090101        N                           
E1354002004any type, replacement only, each                                                                                                                                                                                                                                                                                     
E1355001003Stand/rack                                                                      Oxygen supplies stand/rack  00      960-4                                                                                                 D                          D1C R      01986010120090101        N                           
E1356001003Oxygen accessory, battery pack/cartridge for portable concentrator, any type,   Batt pack/cart, port conc   00      9                                                                                                     C                          D1C APR    02009010120090101        N                           
E1356002004replacement only, each                                                                                                                                                                                                                                                                                               
E1357001003Oxygen accessory, battery charger for portable concentrator, any type,          Battery charger, port conc  00      9                                                                                                     C                          D1C APR    02009010120090101        N                           
E1357002004replacement only, each                                                                                                                                                                                                                                                                                               
E1358001003Oxygen accessory, dc power adapter for portable concentrator, any type,         Dc power adapter, port conc 00      9                                                                                                     D                      0197D1C APR    02009010120150101        N                           
E1358002004replacement only, each                                                                                                                                                                                                                                                                                               
E1372001003Immersion external heater for nebulizer                                         Oxy suppl heater for nebuliz32      A60-4                                                                                                 D                          D1E APR    01986010119960101        N                           
E1390001003Oxygen concentrator, single delivery port, capable of delivering 85 percent or  Oxygen concentrator         33      A60-4                                                                                                 D                          D1C R      02000010120040101        N                           
E1390002004greater oxygen concentration at the prescribed flow rate                                                                                                                                                                                                                                                             
E1391001003Oxygen concentrator, dual delivery port, capable of delivering 85 percent or    Oxygen concentrator, dual   33      A60-4                                                                                                 D                          D1C R      02004010120040101        N                           
E1391002004greater oxygen concentration at the prescribed flow rate, each                                                                                                                                                                                                                                                       
E1392001003Portable oxygen concentrator, rental                                            Portable oxygen concentrator33      A60-4                                                                                                 D                          D1C R      02006010120060101        N                           
E1399001003Durable medical equipment, miscellaneous                                        Durable medical equipment mi46      A                                                                                                     C                          D1E APR    01986010119960101        N                           
E1405001003Oxygen and water vapor enriching system with heated delivery                    O2/water vapor enrich w/heat33      A60-4              4107                                                                               D                          D1C R      01988010119900101        N                           
E1406001003Oxygen and water vapor enriching system without heated delivery                 O2/water vapor enrich w/o he33      A60-4              4107                                                                               D                          D1C R      01988010119900101        N                           
E1500001003Centrifuge, for dialysis                                                        Centrifuge                  00      9                                                                                                     D                      0017P9B L      02002010120150101        N                           
E1510001003Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal Kidney dialysate delivry sys00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1510002004syst, flowrate meter, power off, heater and temperature control with alarm,                                                                                                                                                                                                                                          
E1510003004i.v. poles, pressure gauge, concentrate container                                                                                                                                                                                                                                                                    
E1520001003Heparin infusion pump for hemodialysis                                          Heparin infusion pump       00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1530001003Air bubble detector for hemodialysis, each, replacement                         Replacement air bubble detec00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1540001003Pressure alarm for hemodialysis, each, replacement                              Replacement pressure alarm  00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1550001003Bath conductivity meter for hemodialysis, each                                  Bath conductivity meter     00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1560001003Blood leak detector for hemodialysis, each, replacement                         Replace blood leak detector 00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1570001003Adjustable chair, for esrd patients                                             Adjustable chair for esrd pt00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1575001003Transducer protectors/fluid barriers, for hemodialysis, any size, per 10        Transducer protect/fld bar  00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1580001003Unipuncture control system for hemodialysis                                     Unipuncture control system  00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1590001003Hemodialysis machine                                                            Hemodialysis machine        00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1592001003Automatic intermittent peritoneal dialysis system                               Auto interm peritoneal dialy00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1594001003Cycler dialysis machine for peritoneal dialysis                                 Cycler dialysis machine     00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1600001003Delivery and/or installation charges for hemodialysis equipment                 Deli/install chrg hemo equip00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1610001003Reverse osmosis water purification system, for hemodialysis                     Reverse osmosis h2o puri sys00      955-1A                                                                                                D                      0017P9B L      01986010120150101        N                           
E1615001003Deionizer water purification system, for hemodialysis                           Deionizer h2o puri system   00      955-1A                                                                                                D                      0017P9B L      01986010120150101        N                           
E1620001003Blood pump for hemodialysis, replacement                                        Replacement blood pump      00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1625001003Water softening system, for hemodialysis                                        Water softening system      00      955-1B                                                                                                D                      0017P9B L      01986010120150101        N                           
E1630001003Reciprocating peritoneal dialysis system                                        Reciprocating peritoneal dia00      9                                                                                                     C                      0017P9B L      01986010120150101        N                           
E1632001003Wearable artificial kidney, each                                                Wearable artificial kidney  00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1634001003Peritoneal dialysis clamps, each                                                Peritoneal dialysis clamp   00      9                  4270                                                                               D                          P9B L      02004010120150101        N                           
E1635001003Compact (portable) travel hemodialyzer system                                   Compact travel hemodialyzer 00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1636001003Sorbent cartridges, for hemodialysis, per 10                                    Sorbent cartridges per 10   00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1637001003Hemostats, each                                                                 Hemostats for dialysis, each00      9                                                                                                     D                      0017P9B L      02002010120150101        N                           
E1639001003Scale, each                                                                     Scale, each                 00      9                                                                                                     D                      0017P9B L      02002010120180101        N                           
E1699001003Dialysis equipment, not otherwise specified                                     Dialysis equipment noc      00      9                                                                                                     D                      0017P9B L      01986010120150101        N                           
E1700001003Jaw motion rehabilitation system                                                Jaw motion rehab system     36      A                                                                                                     C                          D1E APR    01993010120140401        N                           
E1701001003Replacement cushions for jaw motion rehabilitation system, pkg. of 6            Repl cushions for jaw motion34      A                                                                                                     C                          D1E P      01993010119960101        N                           
E1702001003Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200  Repl measr scales jaw motion34      A                                                                                                     C                          D1E P      01993010119960101        N                           
E1800001003Dynamic adjustable elbow extension/flexion device, includes soft interface      Adjust elbow ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1800002004material                                                                                                                                                                                                                                                                                                             
E1801001003Static progressive stretch elbow device, extension and/or flexion, with or      Sps elbow device            36      A                                                                                                     C                          D1E PR     02002010120080101        N                           
E1801002004without range of motion adjustment, includes all components and accessories                                                                                                                                                                                                                                          
E1802001003Dynamic adjustable forearm pronation/supination device, includes soft interface Adjst forearm pro/sup device36      A                                                                                                     C                          D1E R      02003010120030101        N                           
E1802002004material                                                                                                                                                                                                                                                                                                             
E1805001003Dynamic adjustable wrist extension / flexion device, includes soft interface    Adjust wrist ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1805002004material                                                                                                                                                                                                                                                                                                             
E1806001003Static progressive stretch wrist device, flexion and/or extension, with or      Sps wrist device            36      A                                                                                                     C                          D1E PR     02002010120080101        N                           
E1806002004without range of motion adjustment, includes all components and accessories                                                                                                                                                                                                                                          
E1810001003Dynamic adjustable knee extension / flexion device, includes soft interface     Adjust knee ext/flex device 36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1810002004material                                                                                                                                                                                                                                                                                                             
E1811001003Static progressive stretch knee device, extension and/or flexion, with or       Sps knee device             36      A                                                                                                     C                          D1E PR     02002010120080101        N                           
E1811002004without range of motion adjustment, includes all components and accessories                                                                                                                                                                                                                                          
E1812001003Dynamic knee, extension/flexion device with active resistance control           Knee ext/flex w act res ctrl36      A                                                                                                     C                          D1E PR     02006010120060101        N                           
E1815001003Dynamic adjustable ankle extension/flexion device, includes soft interface      Adjust ankle ext/flex device36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1815002004material                                                                                                                                                                                                                                                                                                             
E1816001003Static progressive stretch ankle device, flexion and/or extension, with or      Sps ankle device            36      A                                                                                                     C                          D1E PR     02002010120080101        N                           
E1816002004without range of motion adjustment, includes all components and accessories                                                                                                                                                                                                                                          
E1818001003Static progressive stretch forearm pronation / supination device, with or       Sps forearm device          36      A                                                                                                     C                          D1E PR     02002010120080101        N                           
E1818002004without range of motion adjustment, includes all components and accessories                                                                                                                                                                                                                                          
E1820001003Replacement soft interface material, dynamic adjustable extension/flexion deviceSoft interface material     32      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1821001003Replacement soft interface material/cuffs for bi-directional static progressive Replacement interface spsd  32      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1821002004stretch device                                                                                                                                                                                                                                                                                                       
E1825001003Dynamic adjustable finger extension/flexion device, includes soft interface     Adjust finger ext/flex devc 36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1825002004material                                                                                                                                                                                                                                                                                                             
E1830001003Dynamic adjustable toe extension/flexion device, includes soft interface        Adjust toe ext/flex device  36      A                                                                                                     C                          D1E PR     01996010120020101        N                           
E1830002004material                                                                                                                                                                                                                                                                                                             
E1831001003Static progressive stretch toe device, extension and/or flexion, with or        Static str toe dev ext/flex 36      A                                                                                                     C                          D1E PR     02011010120110101        N                           
E1831002004without range of motion adjustment, includes all components and accessories                                                                                                                                                                                                                                          
E1840001003Dynamic adjustable shoulder flexion / abduction / rotation device, includes     Adj shoulder ext/flex device36      A                                                                                                     C                          D1E PR     02002010120020101        N                           
E1840002004soft interface material                                                                                                                                                                                                                                                                                              
E1841001003Static progressive stretch shoulder device, with or without range of motion     Static str shldr dev rom adj36      A                                                                                                     C                          D1E R      02005010120080101        N                           
E1841002004adjustment, includes all components and accessories                                                                                                                                                                                                                                                                  
E1902001003Communication board, non-electronic augmentative or alternative communication   Aac non-electronic board    00      9                                                                                                     C                          Z2  APR    02002010120020101        N                           
E1902002004device                                                                                                                                                                                                                                                                                                               
E2000001003Gastric suction pump, home model, portable or stationary, electric              Gastric suction pump hme mdl36      A                                                                                                     C                          D1E R      02002010120020101        N                           
E2100001003Blood glucose monitor with integrated voice synthesizer                         Bld glucose monitor w voice 32      A60-11                                                                                                D                          D1E APR    02002010120020101        N                           
E2101001003Blood glucose monitor with integrated lancing/blood sample                      Bld glucose monitor w lance 32      A60-11                                                                                                D                          D1E APR    02002010120020101        N                           
E2120001003Pulse generator system for tympanic treatment of inner ear endolymphatic fluid  Pulse gen sys tx endolymp fl36      A                                                                                                     C                          D1E R      02004010120040101        N                           
E2201001003Manual wheelchair accessory, nonstandard seat frame, width greater than or      Man w/ch acc seat w>=20"<24"32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2201002004equal to 20 inches and less than 24 inches                                                                                                                                                                                                                                                                           
E2202001003Manual wheelchair accessory, nonstandard seat frame width, 24-27 inches         Seat width 24-27 in         32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2203001003Manual wheelchair accessory, nonstandard seat frame depth, 20 to less than 22   Frame depth less than 22 in 32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2203002004inches                                                                                                                                                                                                                                                                                                               
E2204001003Manual wheelchair accessory, nonstandard seat frame depth, 22 to 25 inches      Frame depth 22 to 25 in     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2205001003Manual wheelchair accessory, handrim without projections (includes ergonomic or Manual wc accessory, handrim32      A                                                                                                     C                          D1D APR    02005010120080101        N                           
E2205002004contoured), any type, replacement only, each                                                                                                                                                                                                                                                                         
E2206001003Manual wheelchair accessory, wheel lock assembly, complete, replacement only,   Man wc whl lock comp repl ea32      A                                                                                                     C                          D1D APR    02005010120170101        N                           
E2206002004each                                                                                                                                                                                                                                                                                                                 
E2207001003Wheelchair accessory, crutch and cane holder, each                              Crutch and cane holder      32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2208001003Wheelchair accessory, cylinder tank carrier, each                               Cylinder tank carrier       32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2209001003Accessory, arm trough, with or without hand support, each                       Arm trough each             32      A                                                                                                     C                          D1D APR    02006010120070101        N                           
E2210001003Wheelchair accessory, bearings, any type, replacement only, each                Wheelchair bearings         32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2211001003Manual wheelchair accessory, pneumatic propulsion tire, any size, each          Pneumatic propulsion tire   32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2212001003Manual wheelchair accessory, tube for pneumatic propulsion tire, any size, each Pneumatic prop tire tube    32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2213001003Manual wheelchair accessory, insert for pneumatic propulsion tire (removable),  Pneumatic prop tire insert  32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2213002004any type, any size, each                                                                                                                                                                                                                                                                                             
E2214001003Manual wheelchair accessory, pneumatic caster tire, any size, each              Pneumatic caster tire each  32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2215001003Manual wheelchair accessory, tube for pneumatic caster tire, any size, each     Pneumatic caster tire tube  32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2216001003Manual wheelchair accessory, foam filled propulsion tire, any size, each        Foam filled propulsion tire 32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2217001003Manual wheelchair accessory, foam filled caster tire, any size, each            Foam filled caster tire each32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2218001003Manual wheelchair accessory, foam propulsion tire, any size, each               Foam propulsion tire each   32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2219001003Manual wheelchair accessory, foam caster tire, any size, each                   Foam caster tire any size ea32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2220001003Manual wheelchair accessory, solid (rubber/plastic) propulsion tire, any size,  Solid propuls tire, repl, ea32      A                                                                                                     C                          D1D APR    02006010120170101        N                           
E2220002004replacement only, each                                                                                                                                                                                                                                                                                               
E2221001003Manual wheelchair accessory, solid (rubber/plastic) caster tire (removable),    Solid caster tire repl, each32      A                                                                                                     C                          D1D APR    02006010120170101        N                           
E2221002004any size, replacement only, each                                                                                                                                                                                                                                                                                     
E2222001003Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated Solid caster integ whl, repl32      A                                                                                                     C                          D1D APR    02006010120170101        N                           
E2222002004wheel, any size, replacement only, each                                                                                                                                                                                                                                                                              
E2224001003Manual wheelchair accessory, propulsion wheel excludes tire, any size,          Propulsion whl excl tire rep32      A                                                                                                     C                          D1D APR    02006010120170101        N                           
E2224002004replacement only, each                                                                                                                                                                                                                                                                                               
E2225001003Manual wheelchair accessory, caster wheel excludes tire, any size, replacement  Caster wheel excludes tire  32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2225002004only, each                                                                                                                                                                                                                                                                                                           
E2226001003Manual wheelchair accessory, caster fork, any size, replacement only, each      Caster fork replacement only32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2227001003Manual wheelchair accessory, gear reduction drive wheel, each                   Gear reduction drive wheel  36      A                                                                                                     C                          D1D APR    02008010120140401        N                           
E2228001003Manual wheelchair accessory, wheel braking system and lock, complete, each      Mwc acc, wheelchair brake   36      A                                                                                                     C                          D1D APR    02008010120160701        N                           
E2230001003Manual wheelchair accessory, manual standing system                             Manual standing system      00      9                                                                                                     C                          D1D APR    02009010120150101        N                           
E2231001003Manual wheelchair accessory, solid seat support base (replaces sling seat),     Solid seat support base     32      A                                                                                                     C                          D1D APR    02009010120090101        N                           
E2231002004includes any type mounting hardware                                                                                                                                                                                                                                                                                  
E2291001003Back, planar, for pediatric size wheelchair including fixed attaching hardware  Planar back for ped size wc 32      A                                                                                                     C                          D1D APR    02005010120060101        N                           
E2292001003Seat, planar, for pediatric size wheelchair including fixed attaching hardware  Planar seat for ped size wc 32      A                                                                                                     C                          D1D APR    02005010120060101        N                           
E2293001003Back, contoured, for pediatric size wheelchair including fixed attaching        Contour back for ped size wc32      A                                                                                                     C                          D1D APR    02005010120060101        N                           
E2293002004hardware                                                                                                                                                                                                                                                                                                             
E2294001003Seat, contoured, for pediatric size wheelchair including fixed attaching        Contour seat for ped size wc32      A                                                                                                     C                          D1D APR    02005010120060101        N                           
E2294002004hardware                                                                                                                                                                                                                                                                                                             
E2295001003Manual wheelchair accessory, for pediatric size wheelchair, dynamic seating     Ped dynamic seating frame   32      A                                                                                                     C                          D1D APR    02009010120090101        N                           
E2295002004frame, allows coordinated movement of multiple positioning features                                                                                                                                                                                                                                                  
E2300001003Wheelchair accessory, power seat elevation system, any type                     Pwr seat elevation sys      32      A                                                                                                     C                          D1D APR    02004010120140101        N                           
E2301001003Wheelchair accessory, power standing system, any type                           Pwr standing                00      9                                                                                                     C                          D1D APR    02004010120140101        N                           
E2310001003Power wheelchair accessory, electronic connection between wheelchair controller Electro connect btw control 36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2310002004and one power seating system motor, including all related electronics,                                                                                                                                                                                                                                               
E2310003004indicator feature, mechanical function selection switch, and fixed mounting                                                                                                                                                                                                                                          
E2310004004hardware                                                                                                                                                                                                                                                                                                             
E2311001003Power wheelchair accessory, electronic connection between wheelchair controller Electro connect btw 2 sys   36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2311002004and two or more power seating system motors, including all related electronics,                                                                                                                                                                                                                                      
E2311003004indicator feature, mechanical function selection switch, and fixed mounting                                                                                                                                                                                                                                          
E2311004004hardware                                                                                                                                                                                                                                                                                                             
E2312001003Power wheelchair accessory, hand or chin control interface, mini-proportional   Mini-prop remote joystick   36      A                                                                                                     C                          D1D APR    02008010120140401        N                           
E2312002004remote joystick, proportional, including fixed mounting hardware                                                                                                                                                                                                                                                     
E2313001003Power wheelchair accessory, harness for upgrade to expandable controller,       Pwc harness, expand control 36      A                                                                                                     C                          D1D APR    02008010120140401        N                           
E2313002004including all fasteners, connectors and mounting hardware, each                                                                                                                                                                                                                                                      
E2321001003Power wheelchair accessory, hand control interface, remote joystick,            Hand interface joystick     36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2321002004nonproportional, including all related electronics, mechanical stop switch, and                                                                                                                                                                                                                                      
E2321003004fixed mounting hardware                                                                                                                                                                                                                                                                                              
E2322001003Power wheelchair accessory, hand control interface, multiple mechanical         Mult mech switches          36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2322002004switches, nonproportional, including all related electronics, mechanical stop                                                                                                                                                                                                                                        
E2322003004switch, and fixed mounting hardware                                                                                                                                                                                                                                                                                  
E2323001003Power wheelchair accessory, specialty joystick handle for hand control          Special joystick handle     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2323002004interface, prefabricated                                                                                                                                                                                                                                                                                             
E2324001003Power wheelchair accessory, chin cup for chin control interface                 Chin cup interface          32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2325001003Power wheelchair accessory, sip and puff interface, nonproportional, including  Sip and puff interface      36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2325002004all related electronics, mechanical stop switch, and manual swingaway mounting                                                                                                                                                                                                                                       
E2325003004hardware                                                                                                                                                                                                                                                                                                             
E2326001003Power wheelchair accessory, breath tube kit for sip and puff interface          Breath tube kit             36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2327001003Power wheelchair accessory, head control interface, mechanical, proportional,   Head control interface mech 36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2327002004including all related electronics, mechanical direction change switch, and                                                                                                                                                                                                                                           
E2327003004fixed mounting hardware                                                                                                                                                                                                                                                                                              
E2328001003Power wheelchair accessory, head control or extremity control interface,        Head/extremity control inter36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2328002004electronic, proportional, including all related electronics and fixed mounting                                                                                                                                                                                                                                       
E2328003004hardware                                                                                                                                                                                                                                                                                                             
E2329001003Power wheelchair accessory, head control interface, contact switch mechanism,   Head control nonproportional36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2329002004nonproportional, including all related electronics, mechanical stop switch,                                                                                                                                                                                                                                          
E2329003004mechanical direction change switch, head array, and fixed mounting hardware                                                                                                                                                                                                                                          
E2330001003Power wheelchair accessory, head control interface, proximity switch mechanism, Head control proximity switc36      A                                                                                                     C                          D1D APR    02004010120140401        N                           
E2330002004nonproportional, including all related electronics, mechanical stop switch,                                                                                                                                                                                                                                          
E2330003004mechanical direction change switch, head array, and fixed mounting hardware                                                                                                                                                                                                                                          
E2331001003Power wheelchair accessory, attendant control, proportional, including all      Attendant control           32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2331002004related electronics and fixed mounting hardware                                                                                                                                                                                                                                                                      
E2340001003Power wheelchair accessory, nonstandard seat frame width, 20-23 inches          W/c wdth 20-23 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2341001003Power wheelchair accessory, nonstandard seat frame width, 24-27 inches          W/c wdth 24-27 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2342001003Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches       W/c dpth 20-21 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2343001003Power wheelchair accessory, nonstandard seat frame depth, 22-25 inches          W/c dpth 22-25 in seat frame32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2351001003Power wheelchair accessory, electronic interface to operate speech generating   Electronic sgd interface    32      A                                                                                                     C                          D1D APR    02004010120190101        P                           
E2351002004device using power wheelchair control interface                                                                                                                                                                                                                                                                      
E2358001003Power wheelchair accessory, group 34 non-sealed lead acid battery, each         Gr 34 nonsealed leadacid    32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2359001003Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel  Gr34 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2359002004cell, absorbed glassmat)                                                                                                                                                                                                                                                                                             
E2360001003Power wheelchair accessory, 22nf non-sealed lead acid battery, each             22nf nonsealed leadacid     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2361001003Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel     22nf sealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2361002004cell, absorbed glassmat)                                                                                                                                                                                                                                                                                             
E2362001003Power wheelchair accessory, group 24 non-sealed lead acid battery, each         Gr24 nonsealed leadacid     32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2363001003Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel  Gr24 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2363002004cell, absorbed glassmat)                                                                                                                                                                                                                                                                                             
E2364001003Power wheelchair accessory, u-1 non-sealed lead acid battery, each              U1nonsealed leadacid battery32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2365001003Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, U1 sealed leadacid battery  32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2365002004absorbed glassmat)                                                                                                                                                                                                                                                                                                   
E2366001003Power wheelchair accessory, battery charger, single mode, for use with only one Battery charger, single mode32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2366002004battery type, sealed or non-sealed, each                                                                                                                                                                                                                                                                             
E2367001003Power wheelchair accessory, battery charger, dual mode, for use with either     Battery charger, dual mode  32      A                                                                                                     C                          D1D APR    02004010120040101        N                           
E2367002004battery type, sealed or non-sealed, each                                                                                                                                                                                                                                                                             
E2368001003Power wheelchair component, drive wheel motor, replacement only                 Pwr wc drivewheel motor repl36      A                                                                                                     C                          D1D APR    02005010120160701        N                           
E2369001003Power wheelchair component, drive wheel gear box, replacement only              Pwr wc drivewheel gear repl 36      A                                                                                                     C                          D1D APR    02005010120160701        N                           
E2370001003Power wheelchair component, integrated drive wheel motor and gear box           Pwr wc dr wh motor/gear comb36      A                                                                                                     C                          D1D APR    02005010120160701        N                           
E2370002004combination, replacement only                                                                                                                                                                                                                                                                                        
E2371001003Power wheelchair accessory, group 27 sealed lead acid battery, (e.g., gel cell, Gr27 sealed leadacid battery32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2371002004absorbed glassmat), each                                                                                                                                                                                                                                                                                             
E2372001003Power wheelchair accessory, group 27 non-sealed lead acid battery, each         Gr27 non-sealed leadacid    32      A                                                                                                     C                          D1D APR    02006010120060101        N                           
E2373001003Power wheelchair accessory, hand or chin control interface, compact remote      Hand/chin ctrl spec joystick36      A                                                                                                     C                          D1D APR    02007010120140401        N                           
E2373002004joystick, proportional, including fixed mounting hardware                                                                                                                                                                                                                                                            
E2374001003Power wheelchair accessory, hand or chin control interface, standard remote     Hand/chin ctrl std joystick 36      A                                                                                                     D                      0125D1D APR    02007010120140401        N                           
E2374002004joystick (not including controller), proportional, including all related                                                                                                                                                                                                                                             
E2374003004electronics and fixed mounting hardware, replacement only                                                                                                                                                                                                                                                            
E2375001003Power wheelchair accessory, non-expandable controller, including all related    Non-expandable controller   36      A                                                                                                     D                      0125D1D APR    02007010120160701        N                           
E2375002004electronics and mounting hardware, replacement only                                                                                                                                                                                                                                                                  
E2376001003Power wheelchair accessory, expandable controller, including all related        Expandable controller, repl 36      A                                                                                                     D                      0125D1D APR    02007010120140401        N                           
E2376002004electronics and mounting hardware, replacement only                                                                                                                                                                                                                                                                  
E2377001003Power wheelchair accessory, expandable controller, including all related        Expandable controller, initl36      A                                                                                                     D                      0125D1D APR    02007010120140401        N                           
E2377002004electronics and mounting hardware, upgrade provided at initial issue                                                                                                                                                                                                                                                 
E2378001003Power wheelchair component, actuator, replacement only                          Pw actuator replacement     36      A                                                                                                     C                          D1D APR    02013010120140401        N                           
E2381001003Power wheelchair accessory, pneumatic drive wheel tire, any size, replacement   Pneum drive wheel tire      32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2381002004only, each                                                                                                                                                                                                                                                                                                           
E2382001003Power wheelchair accessory, tube for pneumatic drive wheel tire, any size,      Tube, pneum wheel drive tire32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2382002004replacement only, each                                                                                                                                                                                                                                                                                               
E2383001003Power wheelchair accessory, insert for pneumatic drive wheel tire (removable),  Insert, pneum wheel drive   32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2383002004any type, any size, replacement only, each                                                                                                                                                                                                                                                                           
E2384001003Power wheelchair accessory, pneumatic caster tire, any size, replacement only,  Pneumatic caster tire       32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2384002004each                                                                                                                                                                                                                                                                                                                 
E2385001003Power wheelchair accessory, tube for pneumatic caster tire, any size,           Tube, pneumatic caster tire 32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2385002004replacement only, each                                                                                                                                                                                                                                                                                               
E2386001003Power wheelchair accessory, foam filled drive wheel tire, any size, replacement Foam filled drive wheel tire32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2386002004only, each                                                                                                                                                                                                                                                                                                           
E2387001003Power wheelchair accessory, foam filled caster tire, any size, replacement      Foam filled caster tire     32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2387002004only, each                                                                                                                                                                                                                                                                                                           
E2388001003Power wheelchair accessory, foam drive wheel tire, any size, replacement only,  Foam drive wheel tire       32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2388002004each                                                                                                                                                                                                                                                                                                                 
E2389001003Power wheelchair accessory, foam caster tire, any size, replacement only, each  Foam caster tire            32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2390001003Power wheelchair accessory, solid (rubber/plastic) drive wheel tire, any size,  Solid drive wheel tire      32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2390002004replacement only, each                                                                                                                                                                                                                                                                                               
E2391001003Power wheelchair accessory, solid (rubber/plastic) caster tire (removable), any Solid caster tire           32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2391002004size, replacement only, each                                                                                                                                                                                                                                                                                         
E2392001003Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated  Solid caster tire, integrate32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2392002004wheel, any size, replacement only, each                                                                                                                                                                                                                                                                              
E2394001003Power wheelchair accessory, drive wheel excludes tire, any size, replacement    Drive wheel excludes tire   32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2394002004only, each                                                                                                                                                                                                                                                                                                           
E2395001003Power wheelchair accessory, caster wheel excludes tire, any size, replacement   Caster wheel excludes tire  32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2395002004only, each                                                                                                                                                                                                                                                                                                           
E2396001003Power wheelchair accessory, caster fork, any size, replacement only, each       Caster fork                 32      A                                                                                                     D                      0125D1D APR    02007010120070101        N                           
E2397001003Power wheelchair accessory, lithium-based battery, each                         Pwc acc, lith-based battery 32      A                                                                                                     C                          D1D P      02008010120080101        N                           
E2402001003Negative pressure wound therapy electrical pump, stationary or portable         Neg press wound therapy pump36      A                                                                                                     C                          D1E R      02004010120040101        N                           
E2500001003Speech generating device, digitized speech, using pre-recorded messages, less   Sgd digitized pre-rec <=8min32      A60-23                                                                                                D                          D1E APR    02004010120190101        P                           
E2500002004than or equal to 8 minutes recording time                                                                                                                                                                                                                                                                            
E2502001003Speech generating device, digitized speech, using pre-recorded messages,        Sgd prerec msg >8min <=20min32      A60-23                                                                                                D                          D1E APR    02004010120190101        P                           
E2502002004greater than 8 minutes but less than or equal to 20 minutes recording time                                                                                                                                                                                                                                           
E2504001003Speech generating device, digitized speech, using pre-recorded messages,        Sgd prerec msg>20min <=40min32      A60-23                                                                                                D                          D1E APR    02004010120190101        P                           
E2504002004greater than 20 minutes but less than or equal to 40 minutes recording time                                                                                                                                                                                                                                          
E2506001003Speech generating device, digitized speech, using pre-recorded messages,        Sgd prerec msg > 40 min     32      A60-23                                                                                                D                          D1E APR    02004010120190101        P                           
E2506002004greater than 40 minutes recording time                                                                                                                                                                                                                                                                               
E2508001003Speech generating device, synthesized speech, requiring message formulation by  Sgd spelling phys contact   32      A60-23                                                                                                D                          D1E APR    02004010120190101        P                           
E2508002004spelling and access by physical contact with the device                                                                                                                                                                                                                                                              
E2510001003Speech generating device, synthesized speech, permitting multiple methods of    Sgd w multi methods msg/accs32      A60-23                                                                                                D                          D1E APR    02004010120190101        P                           
E2510002004message formulation and multiple methods of device access                                                                                                                                                                                                                                                            
E2511001003Speech generating software program, for personal computer or personal digital   Sgd sftwre prgrm for pc/pda 32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2511002004assistant                                                                                                                                                                                                                                                                                                            
E2512001003Accessory for speech generating device, mounting system                         Sgd accessory, mounting sys 32      A60-23                                                                                                D                          D1E APR    02004010120040101        N                           
E2599001003Accessory for speech generating device, not otherwise classified                Sgd accessory noc           46      A60-23                                                                                                D                          D1E APR    02004010120140401        N                           
E2601001003General use wheelchair seat cushion, width less than 22 inches, any depth       Gen w/c cushion wdth < 22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2602001003General use wheelchair seat cushion, width 22 inches or greater, any depth      Gen w/c cushion wdth >=22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2603001003Skin protection wheelchair seat cushion, width less than 22 inches, any depth   Skin protect wc cus wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2604001003Skin protection wheelchair seat cushion, width 22 inches or greater, any depth  Skin protect wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2605001003Positioning wheelchair seat cushion, width less than 22 inches, any depth       Position wc cush wdth <22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2606001003Positioning wheelchair seat cushion, width 22 inches or greater, any depth      Position wc cush wdth>=22 in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2607001003Skin protection and positioning wheelchair seat cushion, width less than 22     Skin pro/pos wc cus wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2607002004inches, any depth                                                                                                                                                                                                                                                                                                    
E2608001003Skin protection and positioning wheelchair seat cushion, width 22 inches or     Skin pro/pos wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2608002004greater, any depth                                                                                                                                                                                                                                                                                                   
E2609001003Custom fabricated wheelchair seat cushion, any size                             Custom fabricate w/c cushion32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2610001003Wheelchair seat cushion, powered                                                Powered w/c cushion         32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2611001003General use wheelchair back cushion, width less than 22 inches, any height,     Gen use back cush wdth <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2611002004including any type mounting hardware                                                                                                                                                                                                                                                                                 
E2612001003General use wheelchair back cushion, width 22 inches or greater, any height,    Gen use back cush wdth>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2612002004including any type mounting hardware                                                                                                                                                                                                                                                                                 
E2613001003Positioning wheelchair back cushion, posterior, width less than 22 inches, any  Position back cush wd <22in 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2613002004height, including any type mounting hardware                                                                                                                                                                                                                                                                         
E2614001003Positioning wheelchair back cushion, posterior, width 22 inches or greater, any Position back cush wd>=22in 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2614002004height, including any type mounting hardware                                                                                                                                                                                                                                                                         
E2615001003Positioning wheelchair back cushion, posterior-lateral, width less than 22      Pos back post/lat wdth <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2615002004inches, any height, including any type mounting hardware                                                                                                                                                                                                                                                             
E2616001003Positioning wheelchair back cushion, posterior-lateral, width 22 inches or      Pos back post/lat wdth>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2616002004greater, any height, including any type mounting hardware                                                                                                                                                                                                                                                            
E2617001003Custom fabricated wheelchair back cushion, any size, including any type         Custom fab w/c back cushion 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2617002004mounting hardware                                                                                                                                                                                                                                                                                                    
E2619001003Replacement cover for wheelchair seat cushion or back cushion, each             Replace cover w/c seat cush 32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2620001003Positioning wheelchair back cushion, planar back with lateral supports, width   Wc planar back cush wd <22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E2620002004less than 22 inches, any height, including any type mounting hardware                                                                                                                                                                                                                                                
E2621001003Positioning wheelchair back cushion, planar back with lateral supports, width   Wc planar back cush wd>=22in32      A                                                                                                     C                          D1D APR    02005010120050101        N                           
E262100200422 inches or greater, any height, including any type mounting hardware                                                                                                                                                                                                                                               
E2622001003Skin protection wheelchair seat cushion, adjustable, width less than 22 inches, Adj skin pro w/c cus wd<22in32      A                                                                                                     C                          D1D APR    02011010120110101        N                           
E2622002004any depth                                                                                                                                                                                                                                                                                                            
E2623001003Skin protection wheelchair seat cushion, adjustable, width 22 inches or         Adj skin pro wc cus wd>=22in32      A                                                                                                     C                          D1D APR    02011010120110101        N                           
E2623002004greater, any depth                                                                                                                                                                                                                                                                                                   
E2624001003Skin protection and positioning wheelchair seat cushion, adjustable, width less Adj skin pro/pos cus<22in   32      A                                                                                                     C                          D1D APR    02011010120110101        N                           
E2624002004than 22 inches, any depth                                                                                                                                                                                                                                                                                            
E2625001003Skin protection and positioning wheelchair seat cushion, adjustable, width 22   Adj skin pro/pos wc cus>=22 32      A                                                                                                     C                          D1D APR    02011010120110101        N                           
E2625002004inches or greater, any depth                                                                                                                                                                                                                                                                                         
E2626001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Seo mobile arm sup att to wc32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2626002004wheelchair, balanced, adjustable                                                                                                                                                                                                                                                                                     
E2627001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Arm supp att to wc rancho ty32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2627002004wheelchair, balanced, adjustable rancho type                                                                                                                                                                                                                                                                         
E2628001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Mobile arm supports reclinin32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2628002004wheelchair, balanced, reclining                                                                                                                                                                                                                                                                                      
E2629001003Wheelchair accessory, shoulder elbow, mobile arm support attached to            Friction dampening arm supp 32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2629002004wheelchair, balanced, friction arm support (friction dampening to proximal and                                                                                                                                                                                                                                       
E2629003004distal joints)                                                                                                                                                                                                                                                                                                       
E2630001003Wheelchair accessory, shoulder elbow, mobile arm support, monosuspension arm    Monosuspension arm/hand supp32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2630002004and hand support, overhead elbow forearm hand sling support, yoke type                                                                                                                                                                                                                                               
E2630003004suspension support                                                                                                                                                                                                                                                                                                   
E2631001003Wheelchair accessory, addition to mobile arm support, elevating proximal arm    Elevat proximal arm support 32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2632001003Wheelchair accessory, addition to mobile arm support, offset or lateral rocker  Offset/lat rocker arm w/ela 32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E2632002004arm with elastic balance control                                                                                                                                                                                                                                                                                     
E2633001003Wheelchair accessory, addition to mobile arm support, supinator                 Mobile arm support supinator32      A                                                                                                     C                          D1D APR    02012010120120101        N                           
E8000001003Gait trainer, pediatric size, posterior support, includes all accessories and   Posterior gait trainer      00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
E8000002004components                                                                                                                                                                                                                                                                                                           
E8001001003Gait trainer, pediatric size, upright support, includes all accessories and     Upright gait trainer        00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
E8001002004components                                                                                                                                                                                                                                                                                                           
E8002001003Gait trainer, pediatric size, anterior support, includes all accessories and    Anterior gait trainer       00      9                                                                                                     I                          Z2  9      02005010120050101        N                           
E8002002004components                                                                                                                                                                                                                                                                                                           
G0008001003Administration of influenza virus vaccine                                       Admin influenza virus vac   54      A                                                                                                     C                          O1G V      01994010119960101        N                           
G0009001003Administration of pneumococcal vaccine                                          Admin pneumococcal vaccine  54      A                                                                                                     C                          O1G V      01994010119960101        N                           
G0010001003Administration of hepatitis b vaccine                                           Admin hepatitis b vaccine   54      A                                                                                                     C                          O1G 1      01994010119960101        N                           
G0027001003Semen analysis; presence and/or motility of sperm excluding huhner              Semen analysis              21      A                                                    400                                              C                          T1H 5      01995010120031001        N                           
G0068001003Professional services for the administration of anti-infective, pain            Adm of infusion drug in home13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0068002004management, chelation, pulmonary hypertension, and/or inotropic infusion                                                                                                                                                                                                                                             
G0068003004drug(s) for each infusion drug administration calendar day in the individual's                                                                                                                                                                                                                                       
G0068004004home, each 15 minutes                                                                                                                                                                                                                                                                                                
G0069001003Professional services for the administration of subcutaneous immunotherapy for  Adm of immune drug in home  13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0069002004each infusion drug administration calendar day in the individual's home, each                                                                                                                                                                                                                                        
G006900300415 minutes                                                                                                                                                                                                                                                                                                           
G0070001003Professional services for the administration of chemotherapy for each infusion  Adm of chemo drug in home   13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0070002004drug administration calendar day in the individual's home, each 15 minutes                                                                                                                                                                                                                                           
G0071001003Payment for communication technology-based services for 5 minutes or more of a  Comm svcs by rhc/fqhc 5 min 13      A                                                                                                     C                          M5D 1      02019010120190101        A                           
G0071002004virtual (non-face-to-face) communication between an rural health clinic (rhc)                                                                                                                                                                                                                                        
G0071003004or federally qualified health center (fqhc) practitioner and rhc or fqhc                                                                                                                                                                                                                                             
G0071004004patient, or 5 minutes or more of remote evaluation of recorded video and/or                                                                                                                                                                                                                                          
G0071005004images by an rhc or fqhc practitioner, occurring in lieu of an office visit;                                                                                                                                                                                                                                         
G0071006004rhc or fqhc only                                                                                                                                                                                                                                                                                                     
G0076001003Brief (20 minutes) care management home visit for a new patient. for use only   Care manag h vst new pt 20 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0076002004in a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                              
G0076003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0076004004facility)                                                                                                                                                                                                                                                                                                            
G0077001003Limited (30 minutes) care management home visit for a new patient. for use only Care manag h vst new pt 30 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0077002004in a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                              
G0077003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0077004004facility)                                                                                                                                                                                                                                                                                                            
G0078001003Moderate (45 minutes) care management home visit for a new patient. for use     Care manag h vst new pt 45 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0078002004only in a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                         
G0078003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0078004004facility)                                                                                                                                                                                                                                                                                                            
G0079001003Comprehensive (60 minutes) care management home visit for a new patient. for    Care manag h vst new pt 60 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0079002004use only in a medicare-approved cmmi model. (services must be furnished within                                                                                                                                                                                                                                       
G0079003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                         
G0079004004facility)                                                                                                                                                                                                                                                                                                            
G0080001003Extensive (75 minutes) care management home visit for a new patient. for use    Care manag h vst new pt 75 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0080002004only in a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                         
G0080003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0080004004facility)                                                                                                                                                                                                                                                                                                            
G0081001003Brief (20 minutes) care management home visit for an existing patient. for use  Care man h v ext pt 20 mi   13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0081002004only in a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                         
G0081003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0081004004facility)                                                                                                                                                                                                                                                                                                            
G0082001003Limited (30 minutes) care management home visit for an existing patient. for    Care man h v ext pt 30 m    13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0082002004use only in a medicare-approved cmmi model. (services must be furnished within                                                                                                                                                                                                                                       
G0082003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                         
G0082004004facility)                                                                                                                                                                                                                                                                                                            
G0083001003Moderate (45 minutes) care management home visit for an existing patient. for   Care man h v ext pt 45 m    13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0083002004use only in a medicare-approved cmmi model. (services must be furnished within                                                                                                                                                                                                                                       
G0083003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                         
G0083004004facility)                                                                                                                                                                                                                                                                                                            
G0084001003Comprehensive (60 minutes) care management home visit for an existing patient.  Care man h v ext pt 60 m    13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0084002004for use only in a medicare-approved cmmi model. (services must be furnished                                                                                                                                                                                                                                          
G0084003004within a beneficiary's home, domiciliary, rest home, assisted living and/or                                                                                                                                                                                                                                          
G0084004004nursing facility)                                                                                                                                                                                                                                                                                                    
G0085001003Extensive (75 minutes) care management home visit for an existing patient. for  Care man h v ext pt 75 m    13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0085002004use only in a medicare-approved cmmi model. (services must be furnished within                                                                                                                                                                                                                                       
G0085003004a beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                         
G0085004004facility)                                                                                                                                                                                                                                                                                                            
G0086001003Limited (30 minutes) care management home care plan oversight. for use only in  Care man home care plan 30 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0086002004a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                                 
G0086003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0086004004facility)                                                                                                                                                                                                                                                                                                            
G0087001003Comprehensive (60 minutes) care management home care plan oversight. for use    Care man home care plan 60 m13      A                                                                                                     C                          M4A 1      02019010120190101        A                           
G0087002004only in a medicare-approved cmmi model. (services must be furnished within a                                                                                                                                                                                                                                         
G0087003004beneficiary's home, domiciliary, rest home, assisted living and/or nursing                                                                                                                                                                                                                                           
G0087004004facility)                                                                                                                                                                                                                                                                                                            
G0101001003Cervical or vaginal cancer screening; pelvic and clinical breast examination    Ca screen;pelvic/breast exam11      A                                                                                                     D                      0064M1A 1      01998010119980101        N                           
G0102001003Prostate cancer screening; digital rectal examination                           Prostate ca screening; dre  11      A50-55             4182                                                                               D                      0079Y1  1      02000010120000101        N                           
G0103001003Prostate cancer screening; prostate specific antigen test (psa)                 Psa screening               21      A50-55             4182                              310                                              D                      0064T1H 5      02000010120070101        N                           
G0104001003Colorectal cancer screening; flexible sigmoidoscopy                             Ca screen;flexi sigmoidscope11      A                                                                                                     DYY20080101            0064P8C 2      01998010119980101        N                           
G0105001003Colorectal cancer screening; colonoscopy on individual at high risk             Colorectal scrn; hi risk ind11      A                                                                                                     DYY19980101            0064P8D 2      01998010119980101        N                           
G0106001003Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy,     Colon ca screen;barium enema11      A                                                                                                     D                      0064I1D 4      01998010119980101        N                           
G0106002004barium enema                                                                                                                                                                                                                                                                                                         
G0108001003Diabetes outpatient self-management training services, individual, per 30       Diab manage trn  per indiv  11      A                                                                                                     C                      0071Y1  1      01998070120010101        N                           
G0108002004minutes                                                                                                                                                                                                                                                                                                              
G0109001003Diabetes outpatient self-management training services, group session (2 or      Diab manage trn ind/group   11      A                                                                                                     C                      0071Y1  1      01998070120010101        N                           
G0109002004more), per 30 minutes                                                                                                                                                                                                                                                                                                
G0117001003Glaucoma screening for high risk patients furnished by an optometrist or        Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q      02002010120031001        N                           
G0117002004ophthalmologist                                                                                                                                                                                                                                                                                                      
G0118001003Glaucoma screening for high risk patient furnished under the direct supervision Glaucoma scrn hgh risk direc11      A                                                                                                     C                          T2D Q      02002010120020101        N                           
G0118002004of an optometrist or ophthalmologist                                                                                                                                                                                                                                                                                 
G0120001003Colorectal cancer screening; alternative to g0105, screening colonoscopy,       Colon ca scrn; barium enema 11      A                                                                                                     D                      0064I1D 4      01998010119980101        N                           
G0120002004barium enema.                                                                                                                                                                                                                                                                                                        
G0121001003Colorectal cancer screening; colonoscopy on individual not meeting criteria for Colon ca scrn not hi rsk ind11      A                                                                                                     DYY20010701            0064I1D 2      01998010120010701        N                           
G0121002004high risk                                                                                                                                                                                                                                                                                                            
G0122001003Colorectal cancer screening; barium enema                                       Colon ca scrn; barium enema 00      9                                                                                                     M                      0064I1D 4      01998010119980101        N                           
G0123001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Screen cerv/vag thin layer  21      A50-20                                               630                                              D                      0045T1H 5      01998040119980401        N                           
G0123002004in preservative fluid, automated thin layer preparation, screening by                                                                                                                                                                                                                                                
G0123003004cytotechnologist under physician supervision                                                                                                                                                                                                                                                                         
G0124001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Screen c/v thin layer by md 1121    C50-20                                               630                                              D                      0045T1H 5      01998040119980401        N                           
G0124002004in preservative fluid, automated thin layer preparation, requiring                                                                                                                                                                                                                                                   
G0124003004interpretation by physician                                                                                                                                                                                                                                                                                          
G0127001003Trimming of dystrophic nails, any number                                        Trim nail(s)                11      A                  2323    4120                                                                       D                          P5A 2      01998010119980101        N                           
G0128001003Direct (face-to-face with patient) skilled nursing services of a registered     Corf skilled nursing service99      9                                          1833(a)                                                    D                      0070Y2  1      01998040119980401        N                           
G0128002004nurse provided in a comprehensive outpatient rehabilitation facility, each 10                                                                                                                                                                                                                                        
G0128003004minutes beyond the first 5 minutes                                                                                                                                                                                                                                                                                   
G0129001003Occupational therapy services requiring the skills of a qualified occupational  Partial hosp prog service   00      9                                                                                                     C                      0087Y1  U      02000040120080401        N                           
G0129002004therapist, furnished as a component of a partial hospitalization treatment                                                                                                                                                                                                                                           
G0129003004program, per session (45 minutes or more)                                                                                                                                                                                                                                                                            
G0130001003Single energy x-ray absorptiometry (sexa) bone density study, one or more       Single energy x-ray study   11      A50-44                                                                                                DYY20080101                I4B 4      01998070119980701        N                           
G0130002004sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)                                                                                                                                                                                                                                                
G0141001003Screening cytopathology smears, cervical or vaginal, performed by automated     Scr c/v cyto,autosys and md 11      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0141002004system, with manual rescreening, requiring interpretation by physician                                                                                                                                                                                                                                               
G0143001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0143002004in preservative fluid, automated thin layer preparation, with manual screening                                                                                                                                                                                                                                       
G0143003004and rescreening by cytotechnologist under physician supervision                                                                                                                                                                                                                                                      
G0144001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010120030101        N                           
G0144002004in preservative fluid, automated thin layer preparation, with screening by                                                                                                                                                                                                                                           
G0144003004automated system, under physician supervision                                                                                                                                                                                                                                                                        
G0145001003Screening cytopathology, cervical or vaginal (any reporting system), collected  Scr c/v cyto,thinlayer,rescr21      A                                                    630                                              C                      0045T1H 5      01999010120030101        N                           
G0145002004in preservative fluid, automated thin layer preparation, with screening by                                                                                                                                                                                                                                           
G0145003004automated system and manual rescreening under physician supervision                                                                                                                                                                                                                                                  
G0147001003Screening cytopathology smears, cervical or vaginal, performed by automated     Scr c/v cyto, automated sys 21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0147002004system under physician supervision                                                                                                                                                                                                                                                                                   
G0148001003Screening cytopathology smears, cervical or vaginal, performed by automated     Scr c/v cyto, autosys, rescr21      A                                                    630                                              C                      0045T1H 5      01999010119990101        N                           
G0148002004system with manual rescreening                                                                                                                                                                                                                                                                                       
G0151001003Services performed by a qualified physical therapist in the home health or      Hhcp-serv of pt,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070120110101        N                           
G0151002004hospice setting, each 15 minutes                                                                                                                                                                                                                                                                                     
G0152001003Services performed by a qualified occupational therapist in the home health or  Hhcp-serv of ot,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070120110101        N                           
G0152002004hospice setting, each 15 minutes                                                                                                                                                                                                                                                                                     
G0153001003Services performed by a qualified speech-language pathologist in the home       Hhcp-svs of s/l path,ea 15mn00      9                                                                                                     C                      0082Y2  1      01999070120110101        N                           
G0153002004health or hospice setting, each 15 minutes                                                                                                                                                                                                                                                                           
G0154001003Direct skilled nursing services of a licensed nurse (lpn or rn) in the home     Hhcp-svs of rn,ea 15 min    00      9                                                                                                     C                      0082Y2  1      0199907012016030120160229N                           
G0154002004health or hospice setting, each 15 minutes                                                                                                                                                                                                                                                                           
G0155001003Services of clinical social worker in home health or hospice settings, each 15  Hhcp-svs of csw,ea 15 min   00      9                                                                                                     C                      0082Y2  1      01999070120100101        N                           
G0155002004minutes                                                                                                                                                                                                                                                                                                              
G0156001003Services of home health/hospice aide in home health or hospice settings, each   Hhcp-svs of aide,ea 15 min  00      9                                                                                                     C                      0082Y2  1      01999070120100101        N                           
G015600200415 minutes                                                                                                                                                                                                                                                                                                           
G0157001003Services performed by a qualified physical therapist assistant in the home      Hhc pt assistant ea 15      00      9                                                                                                     C                          Y2  1      02011010120110101        N                           
G0157002004health or hospice setting, each 15 minutes                                                                                                                                                                                                                                                                           
G0158001003Services performed by a qualified occupational therapist assistant in the home  Hhc ot assistant ea 15      00      9                                                                                                     C                          Y2  1      02011010120110101        N                           
G0158002004health or hospice setting, each 15 minutes                                                                                                                                                                                                                                                                           
G0159001003Services performed by a qualified physical therapist, in the home health        Hhc pt maint ea 15 min      00      9                                                                                                     C                          Y2  1      02011010120110101        N                           
G0159002004setting, in the establishment or delivery of a safe and effective physical                                                                                                                                                                                                                                           
G0159003004therapy maintenance program, each 15 minutes                                                                                                                                                                                                                                                                         
G0160001003Services performed by a qualified occupational therapist, in the home health    Hhc occup therapy ea 15     00      9                                                                                                     C                          Y2  1      02011010120110101        N                           
G0160002004setting, in the establishment or delivery of a safe and effective occupational                                                                                                                                                                                                                                       
G0160003004therapy maintenance program, each 15 minutes                                                                                                                                                                                                                                                                         
G0161001003Services performed by a qualified speech-language pathologist, in the home      Hhc slp ea 15 min           00      9                                                                                                     C                          Y2  1      02011010120110101        N                           
G0161002004health setting, in the establishment or delivery of a safe and effective                                                                                                                                                                                                                                             
G0161003004speech-language pathology maintenance program, each 15 minutes                                                                                                                                                                                                                                                       
G0162001003Skilled services by a registered nurse (rn) for management and evaluation of    Hhc rn e&m plan svs, 15 min 00      9                                                                                                     C                          Y2  1      02011010120110101        N                           
G0162002004the plan of care; each 15 minutes (the patient's underlying condition or                                                                                                                                                                                                                                             
G0162003004complication requires an rn to ensure that essential non-skilled care achieves                                                                                                                                                                                                                                       
G0162004004its purpose in the home health or hospice setting)                                                                                                                                                                                                                                                                   
G0163001003Skilled services of a licensed nurse (lpn or rn) for the observation and        Hhc lpn/rn obs/asses ea 15  00      9                                                                                                     C                          Y2  1      0201101012017010120161231N                           
G0163002004assessment of the patient's condition, each 15 minutes (the change in the                                                                                                                                                                                                                                            
G0163003004patient's condition requires skilled nursing personnel to identify and evaluate                                                                                                                                                                                                                                      
G0163004004the patient's need for possible modification of treatment in the home health or                                                                                                                                                                                                                                      
G0163005004hospice setting)                                                                                                                                                                                                                                                                                                     
G0164001003Skilled services of a licensed nurse (lpn or rn), in the training and/or        Hhc lis nurse train ea 15   00      9                                                                                                     C                          Y2  1      0201101012017010120161231N                           
G0164002004education of a patient or family member, in the home health or hospice setting,                                                                                                                                                                                                                                      
G0164003004each 15 minutes                                                                                                                                                                                                                                                                                                      
G0166001003External counterpulsation, per treatment session                                Extrnl counterpulse, per tx 11      A35-74                                                                                                D                      0078P6C 1      02000010120000101        N                           
G0168001003Wound closure utilizing tissue adhesive(s) only                                 Wound closure by adhesive   00      9                                                                                                     C                          P6C 1      02000010120000101        N                           
G0173001003Linear accelerator based stereotactic radiosurgery, complete course of therapy  Linear acc stereo radsur com00      9                                                                                                     D                      0094P5E 2      0200008012015010120141231N                           
G0173002004in one session                                                                                                                                                                                                                                                                                                       
G0175001003Scheduled interdisciplinary team conference (minimum of three exclusive of      Opps service,sched team conf00      9                                                                                                     C                      0101M6  1      02000070120000701        N                           
G0175002004patient care nursing staff) with patient present                                                                                                                                                                                                                                                                     
G0176001003Activity therapy, such as music, dance, art or play therapies not for           Opps/php;activity therapy   00      9                                                                                                     D                      0102Y2  U      02001010120010101        N                           
G0176002004recreation, related to the care and treatment of patient's disabling mental                                                                                                                                                                                                                                          
G0176003004health problems, per session (45 minutes or more)                                                                                                                                                                                                                                                                    
G0177001003Training and educational services related to the care and treatment of          Opps/php; train & educ serv 00      9                                                                                                     D                      0102Y2  U      02001010120010101        N                           
G0177002004patient's disabling mental health problems per session (45 minutes or more)                                                                                                                                                                                                                                          
G0179001003Physician re-certification for medicare-covered home health services under a    Md recertification hha pt   11      A                                                                                                     C                          Y1  1      02001010120010101        N                           
G0179002004home health plan of care (patient not present), including contacts with home                                                                                                                                                                                                                                         
G0179003004health agency and review of reports of patient status required by physicians to                                                                                                                                                                                                                                      
G0179004004affirm the initial implementation of the plan of care that meets patient's                                                                                                                                                                                                                                           
G0179005004needs, per re-certification period                                                                                                                                                                                                                                                                                   
G0180001003Physician certification for medicare-covered home health services under a home  Md certification hha patient11      A                                                                                                     C                      0100Y1  1      02000100120001001        N                           
G0180002004health plan of care (patient not present), including contacts with home health                                                                                                                                                                                                                                       
G0180003004agency and review of reports of patient status required by physicians to affirm                                                                                                                                                                                                                                      
G0180004004the initial implementation of the plan of care that meets patient's needs, per                                                                                                                                                                                                                                       
G0180005004certification period                                                                                                                                                                                                                                                                                                 
G0181001003Physician supervision of a patient receiving medicare-covered services provided Home health care supervision11      A                                                                                                     C                          Y1  1      02001010120010101        N                           
G0181002004by a participating home health agency (patient not present) requiring complex                                                                                                                                                                                                                                        
G0181003004and multidisciplinary care modalities involving regular physician development                                                                                                                                                                                                                                        
G0181004004and/or revision of care plans, review of subsequent reports of patient status,                                                                                                                                                                                                                                       
G0181005004review of laboratory and other studies, communication (including telephone                                                                                                                                                                                                                                           
G0181006004calls) with other health care professionals involved in the patient's care,                                                                                                                                                                                                                                          
G0181007004integration of new information into the medical treatment plan and/or                                                                                                                                                                                                                                                
G0181008004adjustment of medical therapy, within a calendar month, 30 minutes or more                                                                                                                                                                                                                                           
G0182001003Physician supervision of a patient under a medicare-approved hospice (patient   Hospice care supervision    11      A                                                                                                     C                          Y1  1      02001010120010101        N                           
G0182002004not present) requiring complex and multidisciplinary care modalities involving                                                                                                                                                                                                                                       
G0182003004regular physician development and/or revision of care plans, review of                                                                                                                                                                                                                                               
G0182004004subsequent reports of patient status, review of laboratory and other studies,                                                                                                                                                                                                                                        
G0182005004communication (including telephone calls) with other health care professionals                                                                                                                                                                                                                                       
G0182006004involved in the patient's care, integration of new information into the medical                                                                                                                                                                                                                                      
G0182007004treatment plan and/or adjustment of medical therapy, within a calendar month,                                                                                                                                                                                                                                        
G018200800430 minutes or more                                                                                                                                                                                                                                                                                                   
G0186001003Destruction of localized lesion of choroid (for example, choroidal              Dstry eye lesn,fdr vssl tech00      9                                                                                                     CYY20080101            0099P4D 2      02001010120010101        N                           
G0186002004neovascularization); photocoagulation, feeder vessel technique (one or more                                                                                                                                                                                                                                          
G0186003004sessions)                                                                                                                                                                                                                                                                                                            
G0202001003Screening mammography, bilateral (2-view study of each breast), including       Scr mammo bi incl cad       13      A                                                                            77067                    C                          I1C 1      0200104012018010120171231N                           
G0202002004computer-aided detection (cad) when performed                                                                                                                                                                                                                                                                        
G0204001003Diagnostic mammography, including computer-aided detection (cad) when           Dx mammo incl cad bi        13      A                                                                            77066                    C                          I1C 4      0200104012018010120171231N                           
G0204002004performed; bilateral                                                                                                                                                                                                                                                                                                 
G0206001003Diagnostic mammography, including computer-aided detection (cad) when           Dx mammo incl cad uni       13      A                                                                            77065                    C                          I1C 4      0200104012018010120171231N                           
G0206002004performed; unilateral                                                                                                                                                                                                                                                                                                
G0219001003Pet imaging whole body; melanoma for non-covered indications                    Pet img wholbod melano nonco00      950-36             4173                                                                               M                          I4B 4      02001070120010701        N                           
G0235001003Pet imaging, any site, not otherwise specified                                  Pet not otherwise specified 00      950-36                                                                                                M                          T2D 1      02006010120060101        N                           
G0237001003Therapeutic procedures to increase strength or endurance of respiratory         Therapeutic procd strg endur11      A                                                                                                     C                          P6C 1UW    02002010120041001        N                           
G0237002004muscles, face to face, one on one, each 15 minutes (includes monitoring)                                                                                                                                                                                                                                             
G0238001003Therapeutic procedures to improve respiratory function, other than described by Oth resp proc, indiv        11      A                                                                                                     C                          P6C 1UW    02002010120041001        N                           
G0238002004g0237, one on one, face to face, per 15 minutes (includes monitoring)                                                                                                                                                                                                                                                
G0239001003Therapeutic procedures to improve respiratory function or increase strength or  Oth resp proc, group        11      A                                                                                                     C                          P6C 1UW    02002010120041001        N                           
G0239002004endurance of respiratory muscles, two or more individuals (includes monitoring)                                                                                                                                                                                                                                      
G0245001003Initial physician evaluation and management of a diabetic patient with diabetic Initial foot exam pt lops   11      A50.81                                                                                                D                          M1A 1      02002070120020701        N                           
G0245002004sensory neuropathy resulting in a loss of protective sensation (lops) which                                                                                                                                                                                                                                          
G0245003004must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical                                                                                                                                                                                                                                       
G0245004004examination that consists of at least the following elements: (a) visual                                                                                                                                                                                                                                             
G0245005004inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a                                                                                                                                                                                                                                         
G0245006004protective sensation, (c) evaluation of foot structure and biomechanics, (d)                                                                                                                                                                                                                                         
G0245007004evaluation of vascular status and skin integrity, and (e) evaluation and                                                                                                                                                                                                                                             
G0245008004recommendation of footwear and (4) patient education                                                                                                                                                                                                                                                                 
G0246001003Follow-up physician evaluation and management of a diabetic patient with        Followup eval of foot pt lop11      A50.81                                                                                                D                          M1B 1      02002070120020701        N                           
G0246002004diabetic sensory neuropathy resulting in a loss of protective sensation (lops)                                                                                                                                                                                                                                       
G0246003004to include at least the following: (1) a patient history, (2) a physical                                                                                                                                                                                                                                             
G0246004004examination that includes: (a) visual inspection of the forefoot, hindfoot and                                                                                                                                                                                                                                       
G0246005004toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot                                                                                                                                                                                                                                       
G0246006004structure and biomechanics, (d) evaluation of vascular status and skin                                                                                                                                                                                                                                               
G0246007004integrity, and (e) evaluation and recommendation of footwear, and (3) patient                                                                                                                                                                                                                                        
G0246008004education                                                                                                                                                                                                                                                                                                            
G0247001003Routine foot care by a physician of a diabetic patient with diabetic sensory    Routine footcare pt w lops  11      A50.81                                                                                                D                          M1B 1      02002070120030701        N                           
G0247002004neuropathy resulting in a loss of protective sensation (lops) to include, the                                                                                                                                                                                                                                        
G0247003004local care of superficial wounds (i.e. superficial to muscle and fascia) and at                                                                                                                                                                                                                                      
G0247004004least the following if present: (1) local care of superficial wounds, (2)                                                                                                                                                                                                                                            
G0247005004debridement of corns and calluses, and (3) trimming and debridement of nails                                                                                                                                                                                                                                         
G0248001003Demonstration, prior to initiation of home inr monitoring, for patient with     Demonstrate use home inr mon11      A50.55                                                                                                D                          M1A 5      02002070120080319        N                           
G0248002004either mechanical heart valve(s), chronic atrial fibrillation, or venous                                                                                                                                                                                                                                             
G0248003004thromboembolism who meets medicare coverage criteria, under the direction of a                                                                                                                                                                                                                                       
G0248004004physician; includes: face-to-face demonstration of use and care of the inr                                                                                                                                                                                                                                           
G0248005004monitor, obtaining at least one blood sample, provision of instructions for                                                                                                                                                                                                                                          
G0248006004reporting home inr test results, and documentation of patient's ability to                                                                                                                                                                                                                                           
G0248007004perform testing and report results                                                                                                                                                                                                                                                                                   
G0249001003Provision of test materials and equipment for home inr monitoring of patient    Provide inr test mater/equip11      A50.55                                                                                                D                          Y1  5      02002070120080319        N                           
G0249002004with either mechanical heart valve(s), chronic atrial fibrillation, or venous                                                                                                                                                                                                                                        
G0249003004thromboembolism who meets medicare coverage criteria; includes: provision of                                                                                                                                                                                                                                         
G0249004004materials for use in the home and reporting of test results to physician;                                                                                                                                                                                                                                            
G0249005004testing not occurring more frequently than once a week; testing materials,                                                                                                                                                                                                                                           
G0249006004billing units of service include 4 tests                                                                                                                                                                                                                                                                             
G0250001003Physician review, interpretation, and patient management of home inr testing    Md inr test revie inter mgmt11      A50.55                                                                                                D                          M1B 1      02002070120080319        N                           
G0250002004for patient with either mechanical heart valve(s), chronic atrial fibrillation,                                                                                                                                                                                                                                      
G0250003004or venous thromboembolism who meets medicare coverage criteria; testing not                                                                                                                                                                                                                                          
G0250004004occurring more frequently than once a week; billing units of service include 4                                                                                                                                                                                                                                       
G0250005004tests                                                                                                                                                                                                                                                                                                                
G0251001003Linear accelerator based stereotactic radiosurgery, delivery including          Linear acc based stero radio00      9                                                                                                     D                      0107I1F 4      0200204012015010120141231N                           
G0251002004collimator changes and custom plugging, fractionated treatment, all lesions,                                                                                                                                                                                                                                         
G0251003004per session, maximum five sessions per course of treatment                                                                                                                                                                                                                                                           
G0252001003Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of  Pet imaging initial dx      00      950-36                                                                                                M                          I2D 4      02002100120021001        N                           
G0252002004breast cancer and/or surgical planning for breast cancer (e.g., initial staging                                                                                                                                                                                                                                      
G0252003004of axillary lymph nodes)                                                                                                                                                                                                                                                                                             
G0255001003Current perception threshold/sensory nerve conduction test, (snct) per limb,    Current percep threshold tst00      950-57                                                                                                M                          T2D 4      02002100120021001        N                           
G0255002004any nerve                                                                                                                                                                                                                                                                                                            
G0257001003Unscheduled or emergency dialysis treatment for an esrd patient in a hospital   Unsched dialysis esrd pt hos00      9                                                                                                     D                      0107P6D 1      02003010120030101        N                           
G0257002004outpatient department that is not certified as an esrd facility                                                                                                                                                                                                                                                      
G0259001003Injection procedure for sacroiliac joint; arthrography                          Inject for sacroiliac joint 00      9                                                                                                     D                      0107O1E 1      02003010120030101        N                           
G0260001003Injection procedure for sacroiliac joint; provision of anesthetic, steroid      Inj for sacroiliac jt anesth00      9                                                                                                     DYY20030101            0107O1E F      02003010120041001        N                           
G0260002004and/or other therapeutic agent, with or without arthrography                                                                                                                                                                                                                                                         
G0268001003Removal of impacted cerumen (one or both ears) by physician on same date of     Removal of impacted wax md  11      A                                                                                                     C                          P6C 2      02003010120030101        N                           
G0268002004service as audiologic function testing                                                                                                                                                                                                                                                                               
G0269001003Placement of occlusive device into either a venous or arterial access site,     Occlusive device in vein art00      9                                                                                                     D                      0108P6D 1      02003010120030101        N                           
G0269002004post surgical or interventional procedure (e.g., angioseal plug, vascular plug)                                                                                                                                                                                                                                      
G0270001003Medical nutrition therapy; reassessment and subsequent intervention(s)          Mnt subs tx for change dx   11      A                                                                                                     C                          M5D 1      02003010120030101        N                           
G0270002004following second referral in same year for change in diagnosis, medical                                                                                                                                                                                                                                              
G0270003004condition or treatment regimen (including additional hours needed for renal                                                                                                                                                                                                                                          
G0270004004disease), individual, face to face with the patient, each 15 minutes                                                                                                                                                                                                                                                 
G0271001003Medical nutrition therapy, reassessment and subsequent intervention(s)          Group mnt 2 or more 30 mins 11      A                                                                                                     C                          M5D 1      02003010120030101        N                           
G0271002004following second referral in same year for change in diagnosis, medical                                                                                                                                                                                                                                              
G0271003004condition, or treatment regimen (including additional hours needed for renal                                                                                                                                                                                                                                         
G0271004004disease), group (2 or more individuals), each 30 minutes                                                                                                                                                                                                                                                             
G0276001003Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar         Pild/placebo control clin tr13      A                                                                                                     DYY20150101            0193P6D 1      02015010120150101        N                           
G0276002004decompression (pild) or placebo-control, performed in an approved coverage with                                                                                                                                                                                                                                      
G0276003004evidence development (ced) clinical trial                                                                                                                                                                                                                                                                            
G0277001003Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval     Hbot, full body chamber, 30m13      A35-10                                                                                                D                      0200P5E 1      02015010120150101        N                           
G0278001003Iliac and/or femoral artery angiography, non-selective, bilateral or            Iliac art angio,cardiac cath11      A                                                                                                     C                          I4A 2      02003010120080101        N                           
G0278002004ipsilateral to catheter insertion, performed at the same time as cardiac                                                                                                                                                                                                                                             
G0278003004catheterization and/or coronary angiography, includes positioning or placement                                                                                                                                                                                                                                       
G0278004004of the catheter in the distal aorta or ipsilateral femoral or iliac artery,                                                                                                                                                                                                                                          
G0278005004injection of dye, production of permanent images, and radiologic supervision                                                                                                                                                                                                                                         
G0278006004and interpretation (list separately in addition to primary procedure)                                                                                                                                                                                                                                                
G0279001003Diagnostic digital breast tomosynthesis, unilateral or bilateral (list          Tomosynthesis, mammo        13      A                                                                                                     C                          I1C 4      02015010120180101        N                           
G0279002004separately in addition to 77065 or 77066)                                                                                                                                                                                                                                                                            
G0281001003Electrical stimulation, (unattended), to one or more areas, for chronic stage   Elec stim unattend for press11      A                                                                                                     C                          P5E 1UW    02003040120030401        N                           
G0281002004iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous                                                                                                                                                                                                                                       
G0281003004stasis ulcers not demonstrating measurable signs of healing after 30 days of                                                                                                                                                                                                                                         
G0281004004conventional care, as part of a therapy plan of care                                                                                                                                                                                                                                                                 
G0282001003Electrical stimulation, (unattended), to one or more areas, for wound care      Elect stim wound care not pd00      9                  35-98                                                                              M                          P5E 1UW    02003040120030401        N                           
G0282002004other than described in g0281                                                                                                                                                                                                                                                                                        
G0283001003Electrical stimulation (unattended), to one or more areas for indication(s)     Elec stim other than wound  11      A                                                                                                     C                          P5E 1UW    02003010120030101        N                           
G0283002004other than wound care, as part of a therapy plan of care                                                                                                                                                                                                                                                             
G0288001003Reconstruction, computed tomographic angiography of aorta for surgical planning Recon, cta for surg plan    11      A                                                                                                     C                          I2B 4      02003010120060101        N                           
G0288002004for vascular surgery                                                                                                                                                                                                                                                                                                 
G0289001003Arthroscopy, knee, surgical, for removal of loose body, foreign body,           Arthro, loose body + chondro11      A                                                                                                     C                          P8A 2      02003010120030101        N                           
G0289002004debridement/shaving of articular cartilage (chondroplasty) at the time of other                                                                                                                                                                                                                                      
G0289003004surgical knee arthroscopy in a different compartment of the same knee                                                                                                                                                                                                                                                
G0293001003Noncovered surgical procedure(s) using conscious sedation, regional, general or Non-cov surg proc,clin trial00      9                                                                                                     D                      0107Y2  2      02003010120030101        N                           
G0293002004spinal anesthesia in a medicare qualifying clinical trial, per day                                                                                                                                                                                                                                                   
G0294001003Noncovered procedure(s) using either no anesthesia or local anesthesia only, in Non-cov proc, clinical trial00      9                                                                                                     D                      0109Y2  2      02003010120030101        N                           
G0294002004a medicare qualifying clinical trial, per day                                                                                                                                                                                                                                                                        
G0295001003Electromagnetic therapy, to one or more areas, for wound care other than        Electromagnetic therapy onc 00      935-98                                                                                                M                          I2B 1UW    02003040120040701        N                           
G0295002004described in g0329 or for other uses                                                                                                                                                                                                                                                                                 
G0296001003Counseling visit to discuss need for lung cancer screening using low dose ct    Visit to determ ldct elig   13      A                                                                                                     C                          M6  1      02015020520150205        N                           
G0296002004scan (ldct) (service is for eligibility determination and shared decision                                                                                                                                                                                                                                            
G0296003004making)                                                                                                                                                                                                                                                                                                              
G0297001003Low dose ct scan (ldct) for lung cancer screening                               Ldct for lung ca screen     13      A                                                                                                     C                          I2B 1      02015020520150205        N                           
G0299001003Direct skilled nursing services of a registered nurse (rn) in the home health   Hhs/hospice of rn ea 15 min 00      9                                                                                                     C                          M5D 1      02015110220151102        N                           
G0299002004or hospice setting, each 15 minutes                                                                                                                                                                                                                                                                                  
G0300001003Direct skilled nursing services of a licensed practical nurse (lpn) in the home Hhs/hospice of lpn ea 15 min00      9                                                                                                     C                          M5D 1      02015110220151102        N                           
G0300002004health or hospice setting, each 15 minutes                                                                                                                                                                                                                                                                           
G0302001003Pre-operative pulmonary surgery services for preparation for lvrs, complete     Pre-op service lvrs complete00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0302002004course of services, to include a minimum of 16 days of services                                                                                                                                                                                                                                                      
G0303001003Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15     Pre-op service lvrs 10-15dos00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0303002004days of services                                                                                                                                                                                                                                                                                                     
G0304001003Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days  Pre-op service lvrs 1-9 dos 00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0304002004of services                                                                                                                                                                                                                                                                                                          
G0305001003Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of      Post op service lvrs min 6  00      9                                                                                                     C                          T2D 1      02004010120040101        N                           
G0305002004services                                                                                                                                                                                                                                                                                                             
G0306001003Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and        Cbc/diffwbc w/o platelet    21      A                                                    400                                              C                          T1D 5      02004010120090101        N                           
G0306002004automated wbc differential count                                                                                                                                                                                                                                                                                     
G0307001003Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)          Cbc without platelet        21      A                                                    400                                              C                          T1D 5      02004010120090101        N                           
G0328001003Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3          Fecal blood scrn immunoassay21      A                                                    310400                                           D                      0064T1H 1      02004010120040101        N                           
G0328002004simultaneous                                                                                                                                                                                                                                                                                                         
G0329001003Electromagnetic therapy, to one or more areas for chronic stage iii and stage   Electromagntic tx for ulcers00      9                                                                                                     C                          I2B 1UW    02004070120040701        N                           
G0329002004iv pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers                                                                                                                                                                                                                                        
G0329003004not demonstrating measurable signs of healing after 30 days of conventional                                                                                                                                                                                                                                          
G0329004004care as part of a therapy plan of care                                                                                                                                                                                                                                                                               
G0333001003Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a      Dispense fee initial 30 day 46      A                                                                                                     D                      0121D1E 9      02006010120060101        N                           
G0333002004beneficiary                                                                                                                                                                                                                                                                                                          
G0337001003Hospice evaluation and counseling services, pre-election                        Hospice evaluation preelecti11      A                                                                                                     C                          M5D 1      02005010120050101        N                           
G0339001003Image-guided robotic linear accelerator-based stereotactic radiosurgery,        Robot lin-radsurg com, first13      A                                                                                                     C                          P5E 1      02004010120140101        N                           
G0339002004complete course of therapy in one session or first session of fractionated                                                                                                                                                                                                                                           
G0339003004treatment                                                                                                                                                                                                                                                                                                            
G0340001003Image-guided robotic linear accelerator-based stereotactic radiosurgery,        Robt lin-radsurg fractx 2-5 13      A                                                                                                     C                          P5E 1      02004010120140101        N                           
G0340002004delivery including collimator changes and custom plugging, fractionated                                                                                                                                                                                                                                              
G0340003004treatment, all lesions, per session, second through fifth sessions, maximum                                                                                                                                                                                                                                          
G0340004004five sessions per course of treatment                                                                                                                                                                                                                                                                                
G0341001003Percutaneous islet cell transplant, includes portal vein catheterization and    Percutaneous islet celltrans13      A260.3 35-82                                                                                          D                          P1G 2      02004100120041001        N                           
G0341002004infusion                                                                                                                                                                                                                                                                                                             
G0342001003Laparoscopy for islet cell transplant, includes portal vein catheterization and Laparoscopy islet cell trans13      A35-82                                                                                                D                          P1G 2      02004100120041001        N                           
G0342002004infusion                                                                                                                                                                                                                                                                                                             
G0343001003Laparotomy for islet cell transplant, includes portal vein catheterization and  Laparotomy islet cell transp13      A35-82                                                                                                D                          P1G 2      02004100120041001        N                           
G0343002004infusion                                                                                                                                                                                                                                                                                                             
G0364001003Bone marrow aspiration performed with bone marrow biopsy through the same       Bone marrow aspirate &biopsy11      A                                                                                                     C                          P6C 2      0200501012018010120171231N                           
G0364002004incision on the same date of service                                                                                                                                                                                                                                                                                 
G0365001003Vessel mapping of vessels for hemodialysis access (services for preoperative    Vessel mapping hemo access  11      A                                                                                                     CYY20120101                P9A 5      02005010120050101        N                           
G0365002004vessel mapping prior to creation of hemodialysis access using an autogenous                                                                                                                                                                                                                                          
G0365003004hemodialysis conduit, including arterial inflow and venous outflow)                                                                                                                                                                                                                                                  
G0372001003Physician service required to establish and document the need for a power       Md service required for pmd 13      A                                                                                                     D                      0128M5D 1      02005102520051025        N                           
G0372002004mobility device                                                                                                                                                                                                                                                                                                      
G0378001003Hospital observation service, per hour                                          Hospital observation per hr 00      9                                                                                                     D                      0107M2A 1      02006010120060101        N                           
G0379001003Direct admission of patient for hospital observation care                       Direct refer hospital observ00      9                                                                                                     D                      0107M2A 1      02006010120100101        N                           
G0380001003Level 1 hospital emergency department visit provided in a type b emergency      Lev 1 hosp type b ed visit  00      9                                                                                                     C                          M3  1      02007010120080101        N                           
G0380002004department; (the ed must meet at least one of the following requirements: (1)                                                                                                                                                                                                                                        
G0380003004it is licensed by the state in which it is located under applicable state law                                                                                                                                                                                                                                        
G0380004004as an emergency room or emergency department; (2) it is held out to the public                                                                                                                                                                                                                                       
G0380005004(by name, posted signs, advertising, or other means) as a place that provides                                                                                                                                                                                                                                        
G0380006004care for emergency medical conditions on an urgent basis without requiring a                                                                                                                                                                                                                                         
G0380007004previously scheduled appointment; or (3) during the calendar year immediately                                                                                                                                                                                                                                        
G0380008004preceding the calendar year in which a determination under 42 cfr 489.24 is                                                                                                                                                                                                                                          
G0380009004being made, based on a representative sample of patient visits that occurred                                                                                                                                                                                                                                         
G0380010004during that calendar year, it provides at least one-third of all of its                                                                                                                                                                                                                                              
G0380011004outpatient visits for the treatment of emergency medical conditions on an                                                                                                                                                                                                                                            
G0380012004urgent basis without requiring a previously scheduled appointment)                                                                                                                                                                                                                                                   
G0381001003Level 2 hospital emergency department visit provided in a type b emergency      Lev 2 hosp type b ed visit  00      9                                                                                                     C                          M3  1      02007010120080101        N                           
G0381002004department; (the ed must meet at least one of the following requirements: (1)                                                                                                                                                                                                                                        
G0381003004it is licensed by the state in which it is located under applicable state law                                                                                                                                                                                                                                        
G0381004004as an emergency room or emergency department; (2) it is held out to the public                                                                                                                                                                                                                                       
G0381005004(by name, posted signs, advertising, or other means) as a place that provides                                                                                                                                                                                                                                        
G0381006004care for emergency medical conditions on an urgent basis without requiring a                                                                                                                                                                                                                                         
G0381007004previously scheduled appointment; or (3) during the calendar year immediately                                                                                                                                                                                                                                        
G0381008004preceding the calendar year in which a determination under 42 cfr 489.24 is                                                                                                                                                                                                                                          
G0381009004being made, based on a representative sample of patient visits that occurred                                                                                                                                                                                                                                         
G0381010004during that calendar year, it provides at least one-third of all of its                                                                                                                                                                                                                                              
G0381011004outpatient visits for the treatment of emergency medical conditions on an                                                                                                                                                                                                                                            
G0381012004urgent basis without requiring a previously scheduled appointment)                                                                                                                                                                                                                                                   
G0382001003Level 3 hospital emergency department visit provided in a type b emergency      Lev 3 hosp type b ed visit  00      9                                                                                                     C                          M3  1      02007010120080101        N                           
G0382002004department; (the ed must meet at least one of the following requirements: (1)                                                                                                                                                                                                                                        
G0382003004it is licensed by the state in which it is located under applicable state law                                                                                                                                                                                                                                        
G0382004004as an emergency room or emergency department; (2) it is held out to the public                                                                                                                                                                                                                                       
G0382005004(by name, posted signs, advertising, or other means) as a place that provides                                                                                                                                                                                                                                        
G0382006004care for emergency medical conditions on an urgent basis without requiring a                                                                                                                                                                                                                                         
G0382007004previously scheduled appointment; or (3) during the calendar year immediately                                                                                                                                                                                                                                        
G0382008004preceding the calendar year in which a determination under 42 cfr 489.24 is                                                                                                                                                                                                                                          
G0382009004being made, based on a representative sample of patient visits that occurred                                                                                                                                                                                                                                         
G0382010004during that calendar year, it provides at least one-third of all of its                                                                                                                                                                                                                                              
G0382011004outpatient visits for the treatment of emergency medical conditions on an                                                                                                                                                                                                                                            
G0382012004urgent basis without requiring a previously scheduled appointment)                                                                                                                                                                                                                                                   
G0383001003Level 4 hospital emergency department visit provided in a type b emergency      Lev 4 hosp type b ed visit  00      9                                                                                                     C                          M3  1      02007010120080101        N                           
G0383002004department; (the ed must meet at least one of the following requirements: (1)                                                                                                                                                                                                                                        
G0383003004it is licensed by the state in which it is located under applicable state law                                                                                                                                                                                                                                        
G0383004004as an emergency room or emergency department; (2) it is held out to the public                                                                                                                                                                                                                                       
G0383005004(by name, posted signs, advertising, or other means) as a place that provides                                                                                                                                                                                                                                        
G0383006004care for emergency medical conditions on an urgent basis without requiring a                                                                                                                                                                                                                                         
G0383007004previously scheduled appointment; or (3) during the calendar year immediately                                                                                                                                                                                                                                        
G0383008004preceding the calendar year in which a determination under 42 cfr 489.24 is                                                                                                                                                                                                                                          
G0383009004being made, based on a representative sample of patient visits that occurred                                                                                                                                                                                                                                         
G0383010004during that calendar year, it provides at least one-third of all of its                                                                                                                                                                                                                                              
G0383011004outpatient visits for the treatment of emergency medical conditions on an                                                                                                                                                                                                                                            
G0383012004urgent basis without requiring a previously scheduled appointment)                                                                                                                                                                                                                                                   
G0384001003Level 5 hospital emergency department visit provided in a type b emergency      Lev 5 hosp type b ed visit  00      9                                                                                                     C                          M3  1      02007010120080101        N                           
G0384002004department; (the ed must meet at least one of the following requirements: (1)                                                                                                                                                                                                                                        
G0384003004it is licensed by the state in which it is located under applicable state law                                                                                                                                                                                                                                        
G0384004004as an emergency room or emergency department; (2) it is held out to the public                                                                                                                                                                                                                                       
G0384005004(by name, posted signs, advertising, or other means) as a place that provides                                                                                                                                                                                                                                        
G0384006004care for emergency medical conditions on an urgent basis without requiring a                                                                                                                                                                                                                                         
G0384007004previously scheduled appointment; or (3) during the calendar year immediately                                                                                                                                                                                                                                        
G0384008004preceding the calendar year in which a determination under 42 cfr 489.24 is                                                                                                                                                                                                                                          
G0384009004being made, based on a representative sample of patient visits that occurred                                                                                                                                                                                                                                         
G0384010004during that calendar year, it provides at least one-third of all of its                                                                                                                                                                                                                                              
G0384011004outpatient visits for the treatment of emergency medical conditions on an                                                                                                                                                                                                                                            
G0384012004urgent basis without requiring a previously scheduled appointment)                                                                                                                                                                                                                                                   
G0389001003Ultrasound b-scan and/or real time with image documentation; for abdominal      Ultrasound exam aaa screen  13      A                                                                                                     D                      0134I3B 4      0200701012017010120161231N                           
G0389002004aortic aneurysm (aaa) screening                                                                                                                                                                                                                                                                                      
G0390001003Trauma response team associated with hospital critical care service             Trauma respons w/hosp criti 00      9                                                                                                     D                      0136M5D 1      02007010120070101        N                           
G0396001003Alcohol and/or substance (other than tobacco) abuse structured assessment       Alcohol/subs interv 15-30mn 11      A                                                                                                     C                          M5D 1      02008010120080101        N                           
G0396002004(e.g., audit, dast), and brief intervention 15 to 30 minutes                                                                                                                                                                                                                                                         
G0397001003Alcohol and/or substance (other than tobacco) abuse structured assessment       Alcohol/subs interv >30 min 11      A                                                                                                     C                          M5D 1      02008010120080101        N                           
G0397002004(e.g., audit, dast), and intervention, greater than 30 minutes                                                                                                                                                                                                                                                       
G0398001003Home sleep study test (hst) with type ii portable monitor, unattended; minimum  Home sleep test/type 2 porta13      A                                                                                                     C                          T2D 5      02008031320080313        N                           
G0398002004of 7 channels: eeg, eog, emg, ecg/heart rate, airflow, respiratory effort and                                                                                                                                                                                                                                        
G0398003004oxygen saturation                                                                                                                                                                                                                                                                                                    
G0399001003Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4  Home sleep test/type 3 porta13      A                                                                                                     C                          T2D 5      02008031320080313        N                           
G0399002004channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen                                                                                                                                                                                                                                              
G0399003004saturation                                                                                                                                                                                                                                                                                                           
G0400001003Home sleep test (hst) with type iv portable monitor, unattended; minimum of 3   Home sleep test/type 4 porta13      A                                                                                                     C                          T2D 5      02008031320080313        N                           
G0400002004channels                                                                                                                                                                                                                                                                                                             
G0402001003Initial preventive physical examination; face-to-face visit, services limited   Initial preventive exam     11      A                                                                                                     C                      0153M1A 1      02009010120090101        N                           
G0402002004to new beneficiary during the first 12 months of medicare enrollment                                                                                                                                                                                                                                                 
G0403001003Electrocardiogram, routine ecg with 12 leads; performed as a screening for the  Ekg for initial prevent exam11      A                                                                                                     C                      0153T2C 5      02009010120090101        N                           
G0403002004initial preventive physical examination with interpretation and report                                                                                                                                                                                                                                               
G0404001003Electrocardiogram, routine ecg with 12 leads; tracing only, without             Ekg tracing for initial prev11      A                                                                                                     C                      0153T2C 5      02009010120090101        N                           
G0404002004interpretation and report, performed as a screening for the initial preventive                                                                                                                                                                                                                                       
G0404003004physical examination                                                                                                                                                                                                                                                                                                 
G0405001003Electrocardiogram, routine ecg with 12 leads; interpretation and report only,   Ekg interpret & report preve11      A                                                                                                     C                      0153T2C 5      02009010120090101        N                           
G0405002004performed as a screening for the initial preventive physical examination                                                                                                                                                                                                                                             
G0406001003Follow-up inpatient consultation, limited, physicians typically spend 15        Inpt/tele follow up 15      13      A                                                                                                     C                          M6  3      02009010120120101        N                           
G0406002004minutes communicating with the patient via telehealth                                                                                                                                                                                                                                                                
G0407001003Follow-up inpatient consultation, intermediate, physicians typically spend 25   Inpt/tele follow up 25      11      A                                                                                                     C                          M6  3      02009010120120101        N                           
G0407002004minutes communicating with the patient via telehealth                                                                                                                                                                                                                                                                
G0408001003Follow-up inpatient consultation, complex, physicians typically spend 35        Inpt/tele follow up 35      11      A                                                                                                     C                          M6  3      02009010120120101        N                           
G0408002004minutes communicating with the patient via telehealth                                                                                                                                                                                                                                                                
G0409001003Social work and psychological services, directly relating to and/or furthering  Corf related serv 15 mins ea13      A                                                                                                     C                          M5D 1      02009010120090101        N                           
G0409002004the patient's rehabilitation goals, each 15 minutes, face-to-face; individual                                                                                                                                                                                                                                        
G0409003004(services provided by a corf-qualified social worker or psychologist in a corf)                                                                                                                                                                                                                                      
G0410001003Group psychotherapy other than of a multiple-family group, in a partial         Grp psych partial hosp 45-5013      A                                                                                                     C                          P6D 1      02009010120090101        N                           
G0410002004hospitalization setting, approximately 45 to 50 minutes                                                                                                                                                                                                                                                              
G0411001003Interactive group psychotherapy, in a partial hospitalization setting,          Inter active grp psych parti13      A                                                                                                     C                          P6D 1      02009010120090101        N                           
G0411002004approximately 45 to 50 minutes                                                                                                                                                                                                                                                                                       
G0412001003Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing            Open tx iliac spine uni/bil 13      A                                                                                                     C                      0155P3D 2      02009010120090101        N                           
G0412002004fracture(s), unilateral or bilateral for pelvic bone fracture patterns which do                                                                                                                                                                                                                                      
G0412003004not disrupt the pelvic ring includes internal fixation, when performed                                                                                                                                                                                                                                               
G0413001003Percutaneous skeletal fixation of posterior pelvic bone fracture and/or         Pelvic ring fracture uni/bil13      A                                                                                                     C                      0155P3D 2      02009010120090101        N                           
G0413002004dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or                                                                                                                                                                                                                                      
G0413003004bilateral, (includes ilium, sacroiliac joint and/or sacrum)                                                                                                                                                                                                                                                          
G0414001003Open treatment of anterior pelvic bone fracture and/or dislocation for fracture Pelvic ring fx treat int fix13      A                                                                                                     C                      0155P3D 2      02009010120090101        N                           
G0414002004patterns which disrupt the pelvic ring, unilateral or bilateral, includes                                                                                                                                                                                                                                            
G0414003004internal fixation when performed (includes pubic symphysis and/or                                                                                                                                                                                                                                                    
G0414004004superior/inferior rami)                                                                                                                                                                                                                                                                                              
G0415001003Open treatment of posterior pelvic bone fracture and/or dislocation, for        Open tx post pelvic fxcture 13      A                                                                                                     C                      0155P3D 2      02009010120090101        N                           
G0415002004fracture patterns which disrupt the pelvic ring, unilateral or bilateral,                                                                                                                                                                                                                                            
G0415003004includes internal fixation, when performed (includes ilium, sacroiliac joint                                                                                                                                                                                                                                         
G0415004004and/or sacrum)                                                                                                                                                                                                                                                                                                       
G0416001003Surgical pathology, gross and microscopic examinations, for prostate needle     Prostate biopsy, any mthd   13      A                                                    610                                              C                          T1G 5      02009010120150101        N                           
G0416002004biopsy, any method                                                                                                                                                                                                                                                                                                   
G0417001003Surgical pathology, gross and microscopic examination, for prostate needle      Sat biopsy prostate 21-40   13      A                                                    610                                              C                          T1G 5      0200901012015010120141231N                           
G0417002004biopsy, any method, 21-40 specimens                                                                                                                                                                                                                                                                                  
G0418001003Surgical pathology, gross and microscopic examination, for prostate needle      Sat biopsy prostate 41-60   13      A                                                    610                                              C                          T1G 5      0200901012015010120141231N                           
G0418002004biopsy, any method, 41-60 specimens                                                                                                                                                                                                                                                                                  
G0419001003Surgical pathology, gross and microscopic examination, for prostate needle      Sat biopsy prostate: >60    13      A                                                    610                                              C                          T1G 5      0200901012015010120141231N                           
G0419002004biopsy, any method, >60 specimens                                                                                                                                                                                                                                                                                    
G0420001003Face-to-face educational services related to the care of chronic kidney         Ed svc ckd ind per session  11      A                                                                                                     C                          M1B 1      02010010120100101        N                           
G0420002004disease; individual, per session, per one hour                                                                                                                                                                                                                                                                       
G0421001003Face-to-face educational services related to the care of chronic kidney         Ed svc ckd grp per session  11      A                                                                                                     C                          M1B 1      02010010120100101        N                           
G0421002004disease; group, per session, per one hour                                                                                                                                                                                                                                                                            
G0422001003Intensive cardiac rehabilitation; with or without continuous ecg monitoring     Intens cardiac rehab w/exerc11      A                                                                                                     C                          M5D 1      02010010120100101        N                           
G0422002004with exercise, per session                                                                                                                                                                                                                                                                                           
G0423001003Intensive cardiac rehabilitation; with or without continuous ecg monitoring;    Intens cardiac rehab no exer11      A                                                                                                     C                          M5D 1      02010010120100101        N                           
G0423002004without exercise, per session                                                                                                                                                                                                                                                                                        
G0424001003Pulmonary rehabilitation, including exercise (includes monitoring), one hour,   Pulmonary rehab w exer      11      A                                                                                                     C                          M5D 1      02010010120100101        N                           
G0424002004per session, up to two sessions per day                                                                                                                                                                                                                                                                              
G0425001003Telehealth consultation, emergency department or initial inpatient, typically   Inpt/ed teleconsult30       13      A                                                                                                     C                          M6  3      02010010120120101        N                           
G042500200430 minutes communicating with the patient via telehealth                                                                                                                                                                                                                                                             
G0426001003Telehealth consultation, emergency department or initial inpatient, typically   Inpt/ed teleconsult50       13      A                                                                                                     C                          M6  3      02010010120120101        N                           
G042600200450 minutes communicating with the patient via telehealth                                                                                                                                                                                                                                                             
G0427001003Telehealth consultation, emergency department or initial inpatient, typically   Inpt/ed teleconsult70       13      A                                                                                                     C                          M6  3      02010010120120101        N                           
G042700200470 minutes or more communicating with the patient via telehealth                                                                                                                                                                                                                                                     
G0428001003Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi,    Collagen meniscus implant   00      9                                                                                                     M                      0169P1G 2      02010052520100525        N                           
G0428002004collagen scaffold, menaflex)                                                                                                                                                                                                                                                                                         
G0429001003Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome   Dermal filler injection(s)  13      A                                                                                                     CYY20170101                P6A 1      02010032320170101        N                           
G0429002004(lds) (e.g., as a result of highly active antiretroviral therapy)                                                                                                                                                                                                                                                    
G0431001003Drug screen, qualitative; multiple drug classes by high complexity test method  Drug screen multiple class  1321    A                                                    340                                              C                          T1H 5      0201001012016010120151231N                           
G0431002004(e.g., immunoassay, enzyme assay), per patient encounter                                                                                                                                                                                                                                                             
G0432001003Infectious agent antibody detection by enzyme immunoassay (eia) technique,      Eia hiv-1/hiv-2 screen      21      A                                                    140220                                           C                      0164T1H 9      02009120820101001        N                           
G0432002004hiv-1 and/or hiv-2, screening                                                                                                                                                                                                                                                                                        
G0433001003Infectious agent antibody detection by enzyme-linked immunosorbent assay        Elisa hiv-1/hiv-2 screen    21      A                                                    140220                                           C                      0164T1H 9      02009120820130101        N                           
G0433002004(elisa) technique, hiv-1 and/or hiv-2, screening                                                                                                                                                                                                                                                                     
G0434001003Drug screen, other than chromatographic; any number of drug classes, by clia    Drug screen multi drug class21      A                                                    340                                              C                          T1H 5      0201101012016010120151231N                           
G0434002004waived test or moderate complexity test, per patient encounter                                                                                                                                                                                                                                                       
G0435001003Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, Oral hiv-1/hiv-2 screen     21      A                                                    140220                                           C                      0164T1H 9      02009120820101001        N                           
G0435002004screening                                                                                                                                                                                                                                                                                                            
G0436001003Smoking and tobacco cessation counseling visit for the asymptomatic patient;    Tobacco-use counsel 3-10 min13      A                                                                            9940699407               C                          P5E 1      0201101012016100120160930N                           
G0436002004intermediate, greater than 3 minutes, up to 10 minutes                                                                                                                                                                                                                                                               
G0437001003Smoking and tobacco cessation counseling visit for the asymptomatic patient;    Tobacco-use counsel>10min   13      A                                                                            9940699407               C                          P5E 1      0201101012016100120160930N                           
G0437002004intensive, greater than 10 minutes                                                                                                                                                                                                                                                                                   
G0438001003Annual wellness visit; includes a personalized prevention plan of service       Ppps, initial visit         13      A                                                                                                     C                          M5D 1      02011010120110101        N                           
G0438002004(pps), initial visit                                                                                                                                                                                                                                                                                                 
G0439001003Annual wellness visit, includes a personalized prevention plan of service       Ppps, subseq visit          13      A                                                                                                     C                          M5D 1      02011010120110101        N                           
G0439002004(pps), subsequent visit                                                                                                                                                                                                                                                                                              
G0442001003Annual alcohol misuse screening, 15 minutes                                     Annual alcohol screen 15 min13      A                                                                                                     C                          Y1  1      02011101420111014        N                           
G0443001003Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes         Brief alcohol misuse counsel13      A                                                                                                     C                          Y1  1      02011101420111014        N                           
G0444001003Annual depression screening, 15 minutes                                         Depression screen annual    13      A                                                                                                     C                          Y1  1      02011101420111014        N                           
G0445001003High intensity behavioral counseling to prevent sexually transmitted infection; High inten beh couns std 30m13      A                                                                                                     C                          Y1  1      02011110820111108        N                           
G0445002004face-to-face, individual, includes: education, skills training and guidance on                                                                                                                                                                                                                                       
G0445003004how to change sexual behavior; performed semi-annually, 30 minutes                                                                                                                                                                                                                                                   
G0446001003Annual, face-to-face intensive behavioral therapy for cardiovascular disease,   Intens behave ther cardio dx13      A                                                                                                     C                          Y1  1      02011110820111108        N                           
G0446002004individual, 15 minutes                                                                                                                                                                                                                                                                                               
G0447001003Face-to-face behavioral counseling for obesity, 15 minutes                      Behavior counsel obesity 15m13      A                                                                                                     C                          Y1  1      02011112920111129        N                           
G0448001003Insertion or replacement of a permanent pacing cardioverter-defibrillator       Place perm pacing cardiovert13      A                                                                                                     C                          Y1  2      02012010120140101        N                           
G0448002004system with transvenous lead(s), single or dual chamber with insertion of                                                                                                                                                                                                                                            
G0448003004pacing electrode, cardiac venous system, for left ventricular pacing                                                                                                                                                                                                                                                 
G0451001003Development testing, with interpretation and report, per standardized           Devlopment test interpt&rep 13      A                                                                                                     C                          M5D 1      02012010120120101        N                           
G0451002004instrument form                                                                                                                                                                                                                                                                                                      
G0452001003Molecular pathology procedure; physician interpretation and report              Molecular pathology interpr 13      A                                                                                                     C                          T2D 1      02013010120130101        N                           
G0453001003Continuous intraoperative neurophysiology monitoring, from outside the          Cont intraop neuro monitor  13      A                                                                                                     C                          T2D 1      02013010120130101        N                           
G0453002004operating room (remote or nearby), per patient, (attention directed exclusively                                                                                                                                                                                                                                      
G0453003004to one patient) each 15 minutes (list in addition to primary procedure)                                                                                                                                                                                                                                              
G0454001003Physician documentation of face-to-face visit for durable medical equipment     Md document visit by npp    13      A                                                                                                     C                          M5D 1      02013010120130101        N                           
G0454002004determination performed by nurse practitioner, physician assistant or clinical                                                                                                                                                                                                                                       
G0454003004nurse specialist                                                                                                                                                                                                                                                                                                     
G0455001003Preparation with instillation of fecal microbiota by any method, including      Fecal microbiota prep instil13      A                                                                                                     C                          T2D 1      02013010120130101        N                           
G0455002004assessment of donor specimen                                                                                                                                                                                                                                                                                         
G0456001003Negative pressure wound therapy, (e.g. vacuum assisted drainage collection)     Neg pre wound <=50 sq cm    13      A                                                                                                     C                          P6A 1      0201301012015010120141231N                           
G0456002004using a mechanically-powered device, not durable medical equipment, including                                                                                                                                                                                                                                        
G0456003004provision of cartridge and dressing(s), topical application(s), wound                                                                                                                                                                                                                                                
G0456004004assessment, and instructions for ongoing care, per session; total wounds(s)                                                                                                                                                                                                                                          
G0456005004surface area less than or equal to 50 square centimeters                                                                                                                                                                                                                                                             
G0457001003Negative pressure wound therapy, (e.g. vacuum assisted drainage collection)     Neg pres wound >50 sq cm    13      A                                                                                                     C                          P6A 1      0201301012015010120141231N                           
G0457002004using a mechanically-powered device, not durable medical equipment, including                                                                                                                                                                                                                                        
G0457003004provision of cartridge and dressing(s), topical application(s), wound                                                                                                                                                                                                                                                
G0457004004assessment, and instructions for ongoing care, per session; total wounds(s)                                                                                                                                                                                                                                          
G0457005004surface area greater than 50 square centimeters                                                                                                                                                                                                                                                                      
G0458001003Low dose rate (ldr) prostate brachytherapy services, composite rate             Ldr prostate brachy comp rat00      9                                                                                                     C                      0185P7A 6      02013010120180101        N                           
G0459001003Inpatient telehealth pharmacologic management, including prescription, use, and Telehealth inpt pharm mgmt  13      A                                                                                                     C                          M5D 1      02012080220120802        N                           
G0459002004review of medication with no more than minimal medical psychotherapy                                                                                                                                                                                                                                                 
G0460001003Autologous platelet rich plasma for chronic wounds/ulcers, including            Autologous prp for ulcers   13      A                                                                                                     C                          P5E 1      02012080220120802        N                           
G0460002004phlebotomy, centrifugation, and all other preparatory procedures,                                                                                                                                                                                                                                                    
G0460003004administration and dressings, per treatment                                                                                                                                                                                                                                                                          
G0461001003Immunohistochemistry or immunocytochemistry, per specimen; first single or      Immunohisto/cyto chem 1st st13      A                                                    220610                                           C                          T1G 5      0201401012015010120141231N                           
G0461002004multiplex antibody stain                                                                                                                                                                                                                                                                                             
G0462001003Immunohistochemistry or immunocytochemistry, per specimen; each additional      Immunohisto/cyto chem add   13      A                                                    220610                                           C                          T1G 5      0201401012015010120141231N                           
G0462002004single or multiplex antibody stain (list separately in addition to code for                                                                                                                                                                                                                                          
G0462003004primary procedure)                                                                                                                                                                                                                                                                                                   
G0463001003Hospital outpatient clinic visit for assessment and management of a patient     Hospital outpt clinic visit 00      9                                                                                                     C                          M1B 1      02014010120140101        N                           
G0464001003Colorectal cancer screening; stool-based dna and fecal occult hemoglobin (e.g., Colorec ca scr, sto bas dna 21      A                                                    220310900               81528                    C                          T1H 5      0201410092016010120151231N                           
G0464002004kras, ndrg4 and bmp3)                                                                                                                                                                                                                                                                                                
G0466001003Federally qualified health center (fqhc) visit, new patient; a                  Fqhc visit new patient      13      A                                                                                                     C                          M1A 1      02014100120141001        N                           
G0466002004medically-necessary, face-to-face encounter (one-on-one) between a new patient                                                                                                                                                                                                                                       
G0466003004and a fqhc practitioner during which time one or more fqhc services are                                                                                                                                                                                                                                              
G0466004004rendered and includes a typical bundle of medicare-covered services that would                                                                                                                                                                                                                                       
G0466005004be furnished per diem to a patient receiving a fqhc visit                                                                                                                                                                                                                                                            
G0467001003Federally qualified health center (fqhc) visit, established patient; a          Fqhc visit, estab pt        13      A                                                                                                     C                          M1B 1      02014100120141001        N                           
G0467002004medically-necessary, face-to-face encounter (one-on-one) between an established                                                                                                                                                                                                                                      
G0467003004patient and a fqhc practitioner during which time one or more fqhc services are                                                                                                                                                                                                                                      
G0467004004rendered and includes a typical bundle of medicare-covered services that would                                                                                                                                                                                                                                       
G0467005004be furnished per diem to a patient receiving a fqhc visit                                                                                                                                                                                                                                                            
G0468001003Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that  Fqhc visit, ippe or awv     13      A                                                                                                     C                          M1B 1      02014100120141001        N                           
G0468002004includes an initial preventive physical examination (ippe) or annual wellness                                                                                                                                                                                                                                        
G0468003004visit (awv) and includes a typical bundle of medicare-covered services that                                                                                                                                                                                                                                          
G0468004004would be furnished per diem to a patient receiving an ippe or awv                                                                                                                                                                                                                                                    
G0469001003Federally qualified health center (fqhc) visit, mental health, new patient; a   Fqhc visit, mh new pt       13      A                                                                                                     C                          M1A 1      02014100120141001        N                           
G0469002004medically-necessary, face-to-face mental health encounter (one-on-one) between                                                                                                                                                                                                                                       
G0469003004a new patient and a fqhc practitioner during which time one or more fqhc                                                                                                                                                                                                                                             
G0469004004services are rendered and includes a typical bundle of medicare-covered                                                                                                                                                                                                                                              
G0469005004services that would be furnished per diem to a patient receiving a mental                                                                                                                                                                                                                                            
G0469006004health visit                                                                                                                                                                                                                                                                                                         
G0470001003Federally qualified health center (fqhc) visit, mental health, established      Fqhc visit, mh estab pt     13      A                                                                                                     C                          M1B 1      02014100120141001        N                           
G0470002004patient; a medically-necessary, face-to-face mental health encounter                                                                                                                                                                                                                                                 
G0470003004(one-on-one) between an established patient and a fqhc practitioner during                                                                                                                                                                                                                                           
G0470004004which time one or more fqhc services are rendered and includes a typical bundle                                                                                                                                                                                                                                      
G0470005004of medicare-covered services that would be furnished per diem to a patient                                                                                                                                                                                                                                           
G0470006004receiving a mental health visit                                                                                                                                                                                                                                                                                      
G0471001003Collection of venous blood by venipuncture or urine sample by catheterization   Ven blood coll snf/hha      21      A                                                                                                     C                          Z2  5      02014040120140401        N                           
G0471002004from an individual in a skilled nursing facility (snf) or by a laboratory on                                                                                                                                                                                                                                         
G0471003004behalf of a home health agency (hha)                                                                                                                                                                                                                                                                                 
G0472001003Hepatitis c antibody screening, for individual at high risk and other covered   Hep c screen high risk/other1321    A                                          1861SSA   220                                              D                      0199P5E 5      02014060220160101        N                           
G0472002004indication(s)                                                                                                                                                                                                                                                                                                        
G0473001003Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes        Group behave couns 2-10     13      A                                                                                                     C                          M1B 1      02015010120150101        N                           
G0475001003Hiv antigen/antibody, combination assay, screening                              Hiv combination assay       13      A                                                    140220                                           C                          T2D 5      02015041320150413        N                           
G0476001003Infectious agent detection by nucleic acid (dna or rna); human papillomavirus   Hpv combo assay ca screen   13      A                                                    140                                              C                          T2D 5      02015070920150709        N                           
G0476002004(hpv), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59,                                                                                                                                                                                                                                        
G047600300468) for cervical cancer screening, must be performed in addition to pap test                                                                                                                                                                                                                                         
G0477001003Drug test(s), presumptive, any number of drug classes; any number of devices or Drug test presump optical   21      A                                                                            80305                    C                          T1H 5      0201601012017010120161231N                           
G0477002004procedures, (e.g., immunoassay) capable of being read by direct optical                                                                                                                                                                                                                                              
G0477003004observation only (e.g., dipsticks, cups, cards, cartridges), includes sample                                                                                                                                                                                                                                         
G0477004004validation when performed, per date of service                                                                                                                                                                                                                                                                       
G0478001003Drug test(s), presumptive, any number of drug classes; any number of devices or Drug test presump opt inst  21      A                                                                            80306                    C                          T1H 5      0201601012017010120161231N                           
G0478002004procedures, (e.g., immunoassay) read by instrument-assisted direct optical                                                                                                                                                                                                                                           
G0478003004observation (e.g., dipsticks, cups, cards, cartridges), includes sample                                                                                                                                                                                                                                              
G0478004004validation when performed, per date of service                                                                                                                                                                                                                                                                       
G0479001003Drug test(s), presumptive, any number of drug classes; any number of devices or Drug test presump not opt   21      A                                                                            80307                    C                          T1H 5      0201601012017010120161231N                           
G0479002004procedures by instrumented chemistry analyzers utilizing immunoassay, enzyme                                                                                                                                                                                                                                         
G0479003004assay, tof, maldi, ldtd, desi, dart, ghpc, gc mass spectrometry), includes                                                                                                                                                                                                                                           
G0479004004sample validation when performed, per date of service                                                                                                                                                                                                                                                                
G0480001003Drug test(s), definitive, utilizing (1) drug identification methods able to     Drug test def 1-7 classes   21      A                                                    340                                              C                          T1H 5      02016010120170101        N                           
G0480002004identify individual drugs and distinguish between structural isomers (but not                                                                                                                                                                                                                                        
G0480003004necessarily stereoisomers), including, but not limited to gc/ms (any type,                                                                                                                                                                                                                                           
G0480004004single or tandem) and lc/ms (any type, single or tandem and excluding                                                                                                                                                                                                                                                
G0480005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,                                                                                                                                                                                                                                         
G0480006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized                                                                                                                                                                                                                                          
G0480007004internal standards in all samples (e.g., to control for matrix effects,                                                                                                                                                                                                                                              
G0480008004interferences and variations in signal strength), and (3) method or                                                                                                                                                                                                                                                  
G0480009004drug-specific calibration and matrix-matched quality control material (e.g., to                                                                                                                                                                                                                                      
G0480010004control for instrument variations and mass spectral drift); qualitative or                                                                                                                                                                                                                                           
G0480011004quantitative, all sources, includes specimen validity testing, per day; 1-7                                                                                                                                                                                                                                          
G0480012004drug class(es), including metabolite(s) if performed                                                                                                                                                                                                                                                                 
G0481001003Drug test(s), definitive, utilizing (1) drug identification methods able to     Drug test def 8-14 classes  21      A                                                    340                                              C                          T1H 5      02016010120170101        N                           
G0481002004identify individual drugs and distinguish between structural isomers (but not                                                                                                                                                                                                                                        
G0481003004necessarily stereoisomers), including, but not limited to gc/ms (any type,                                                                                                                                                                                                                                           
G0481004004single or tandem) and lc/ms (any type, single or tandem and excluding                                                                                                                                                                                                                                                
G0481005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,                                                                                                                                                                                                                                         
G0481006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized                                                                                                                                                                                                                                          
G0481007004internal standards in all samples (e.g., to control for matrix effects,                                                                                                                                                                                                                                              
G0481008004interferences and variations in signal strength), and (3) method or                                                                                                                                                                                                                                                  
G0481009004drug-specific calibration and matrix-matched quality control material (e.g., to                                                                                                                                                                                                                                      
G0481010004control for instrument variations and mass spectral drift); qualitative or                                                                                                                                                                                                                                           
G0481011004quantitative, all sources, includes specimen validity testing, per day; 8-14                                                                                                                                                                                                                                         
G0481012004drug class(es), including metabolite(s) if performed                                                                                                                                                                                                                                                                 
G0482001003Drug test(s), definitive, utilizing (1) drug identification methods able to     Drug test def 15-21 classes 21      A                                                    340                                              C                          T1H 5      02016010120170101        N                           
G0482002004identify individual drugs and distinguish between structural isomers (but not                                                                                                                                                                                                                                        
G0482003004necessarily stereoisomers), including, but not limited to gc/ms (any type,                                                                                                                                                                                                                                           
G0482004004single or tandem) and lc/ms (any type, single or tandem and excluding                                                                                                                                                                                                                                                
G0482005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,                                                                                                                                                                                                                                         
G0482006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized                                                                                                                                                                                                                                          
G0482007004internal standards in all samples (e.g., to control for matrix effects,                                                                                                                                                                                                                                              
G0482008004interferences and variations in signal strength), and (3) method or                                                                                                                                                                                                                                                  
G0482009004drug-specific calibration and matrix-matched quality control material (e.g., to                                                                                                                                                                                                                                      
G0482010004control for instrument variations and mass spectral drift); qualitative or                                                                                                                                                                                                                                           
G0482011004quantitative, all sources, includes specimen validity testing, per day; 15-21                                                                                                                                                                                                                                        
G0482012004drug class(es), including metabolite(s) if performed                                                                                                                                                                                                                                                                 
G0483001003Drug test(s), definitive, utilizing (1) drug identification methods able to     Drug test def 22+ classes   21      A                                                    340                                              C                          T1H 5      02016010120170101        N                           
G0483002004identify individual drugs and distinguish between structural isomers (but not                                                                                                                                                                                                                                        
G0483003004necessarily stereoisomers), including, but not limited to gc/ms (any type,                                                                                                                                                                                                                                           
G0483004004single or tandem) and lc/ms (any type, single or tandem and excluding                                                                                                                                                                                                                                                
G0483005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,                                                                                                                                                                                                                                         
G0483006004alcohol dehydrogenase)), (2) stable isotope or other universally recognized                                                                                                                                                                                                                                          
G0483007004internal standards in all samples (e.g., to control for matrix effects,                                                                                                                                                                                                                                              
G0483008004interferences and variations in signal strength), and (3) method or                                                                                                                                                                                                                                                  
G0483009004drug-specific calibration and matrix-matched quality control material (e.g., to                                                                                                                                                                                                                                      
G0483010004control for instrument variations and mass spectral drift); qualitative or                                                                                                                                                                                                                                           
G0483011004quantitative, all sources, includes specimen validity testing, per day; 22 or                                                                                                                                                                                                                                        
G0483012004more drug class(es), including metabolite(s) if performed                                                                                                                                                                                                                                                            
G0490001003Face-to-face home health nursing visit by a rural health clinic (rhc) or        Home visit rn, lpn by rhc/fq13      A                                                                                                     C                          M4A 1      02016040120160401        N                           
G0490002004federally qualified health center (fqhc) in an area with a shortage of home                                                                                                                                                                                                                                          
G0490003004health agencies;  (services limited to rn or lpn only)                                                                                                                                                                                                                                                               
G0491001003Dialysis procedure at a medicare certified esrd facility for acute kidney       Dialysis acu kidney no esrd 13      A                                                                                                     C                          P9A 1      02017010120170101        N                           
G0491002004injury without esrd                                                                                                                                                                                                                                                                                                  
G0492001003Dialysis procedure with single evaluation by a physician or other qualified     Md/oth eval acut kid no esrd13      A                                                                                                     C                          P9A 1      02017010120170101        N                           
G0492002004health care professional  for acute kidney injury without esrd                                                                                                                                                                                                                                                       
G0493001003Skilled services of a registered nurse (rn) for the observation and assessment  Rn care ea 15 min hh/hospice00      9                                                                                                     C                          Y2  1      02017010120170101        N                           
G0493002004of the patient's condition, each 15 minutes (the change in the patient's                                                                                                                                                                                                                                             
G0493003004condition requires skilled nursing personnel to identify and evaluate the                                                                                                                                                                                                                                            
G0493004004patient's need for possible modification of treatment in the home health or                                                                                                                                                                                                                                          
G0493005004hospice setting)                                                                                                                                                                                                                                                                                                     
G0494001003Skilled services of a licensed practical nurse (lpn) for the observation and    Lpn care ea 15min hh/hospice00      9                                                                                                     C                          Y2  1      02017010120170101        N                           
G0494002004assessment of the patient's condition, each 15 minutes (the change in the                                                                                                                                                                                                                                            
G0494003004patient's condition requires skilled nursing personnel to identify and evaluate                                                                                                                                                                                                                                      
G0494004004the patient's need for possible modification of treatment in the home health or                                                                                                                                                                                                                                      
G0494005004hospice setting)                                                                                                                                                                                                                                                                                                     
G0495001003Skilled services of a registered nurse (rn), in the training and/or education   Rn care train/edu in hh     00      9                                                                                                     C                          Y2  1      02017010120170101        N                           
G0495002004of a patient or family member, in the home health or hospice setting, each 15                                                                                                                                                                                                                                        
G0495003004minutes                                                                                                                                                                                                                                                                                                              
G0496001003Skilled services of a licensed practical nurse (lpn), in the training and/or    Lpn care train/edu in hh    00      9                                                                                                     C                          Y2  1      02017010120170101        N                           
G0496002004education of a patient or family member, in the home health or hospice setting,                                                                                                                                                                                                                                      
G0496003004each 15 minutes                                                                                                                                                                                                                                                                                                      
G0498001003Chemotherapy administration, intravenous infusion technique; initiation of      Chemo extend iv infus w/pump13      A                                                                                                     C                          P7B 1      02016010120160101        N                           
G0498002004infusion in the office/clinic setting using office/clinic pump/supplies, with                                                                                                                                                                                                                                        
G0498003004continuation of the infusion in the community setting (e.g., home, domiciliary,                                                                                                                                                                                                                                      
G0498004004rest home or assisted living) using a portable pump provided by the                                                                                                                                                                                                                                                  
G0498005004office/clinic, includes follow up office/clinic visit at the conclusion of the                                                                                                                                                                                                                                       
G0498006004infusion                                                                                                                                                                                                                                                                                                             
G0499001003Hepatitis b screening in non-pregnant, high risk individual includes hepatitis  Hepb screen high risk indiv 13      A                                                    140220                                           C                          T1H 5      02016092820180401        C                           
G0499002004b surface antigen (hbsag), antibodies to hbsag (anti-hbs) and antibodies to                                                                                                                                                                                                                                          
G0499003004hepatitis b core antigen (anti-hbc), and is followed by a neutralizing                                                                                                                                                                                                                                               
G0499004004confirmatory test, when performed, only for an initially reactive hbsag result                                                                                                                                                                                                                                       
G0500001003Moderate sedation services provided by the same physician or other qualified    Mod sedat endo service >5yrs13      A                                                                                                     C                          P0  1      02017010120170101        N                           
G0500002004health care professional performing a gastrointestinal endoscopic service that                                                                                                                                                                                                                                       
G0500003004sedation supports, requiring the presence of an independent trained observer to                                                                                                                                                                                                                                      
G0500004004assist in the monitoring of the patient's level of consciousness and                                                                                                                                                                                                                                                 
G0500005004physiological status; initial 15 minutes of intra-service time; patient age 5                                                                                                                                                                                                                                        
G0500006004years or older (additional time may be reported with 99153, as appropriate)                                                                                                                                                                                                                                          
G0501001003Resource-intensive services for patients for whom the use of specialized        Resource-inten svc during ov13      A                                                                                                     C                          M5D 1      02017010120170101        N                           
G0501002004mobility-assistive technology (such as adjustable height chairs or tables,                                                                                                                                                                                                                                           
G0501003004patient lift, and adjustable padded leg supports) is medically necessary and                                                                                                                                                                                                                                         
G0501004004used during the provision of an office/outpatient, evaluation and management                                                                                                                                                                                                                                         
G0501005004 visit (list separately in addition to primary service)                                                                                                                                                                                                                                                              
G0502001003Initial psychiatric collaborative care management, first 70 minutes in the      Init psych care manag, 70min13      A                                                                            99492                    C                          M5D 1      0201701012018010120171231N                           
G0502002004first calendar month of behavioral health care manager activities, in                                                                                                                                                                                                                                                
G0502003004consultation with a psychiatric consultant, and directed by the treating                                                                                                                                                                                                                                             
G0502004004physician or other qualified health care professional, with the following                                                                                                                                                                                                                                            
G0502005004required elements: outreach to and engagement in treatment of a patient                                                                                                                                                                                                                                              
G0502006004directed by the treating physician or other qualified health care professional;                                                                                                                                                                                                                                      
G0502007004initial assessment of the patient, including administration of validated rating                                                                                                                                                                                                                                      
G0502008004scales, with the development of an individualized treatment plan;  review by                                                                                                                                                                                                                                         
G0502009004the psychiatric consultant with modifications of the plan if recommended;                                                                                                                                                                                                                                            
G0502010004entering patient in a registry and tracking patient follow-up and progress                                                                                                                                                                                                                                           
G0502011004using the registry, with appropriate documentation, and participation in weekly                                                                                                                                                                                                                                      
G0502012004caseload consultation with the psychiatric consultant; and provision of brief                                                                                                                                                                                                                                        
G0502013004interventions using evidence-based techniques such as behavioral activation,                                                                                                                                                                                                                                         
G0502014004motivational interviewing, and other focused treatment strategies                                                                                                                                                                                                                                                    
G0503001003Subsequent psychiatric collaborative care management, first 60 minutes in a     Subseq  psych care man,60mi 13      A                                                                            99493                    C                          M5D 1      0201701012018010120171231N                           
G0503002004subsequent month of behavioral health care manager activities, in consultation                                                                                                                                                                                                                                       
G0503003004with a psychiatric consultant, and directed by the treating physician or other                                                                                                                                                                                                                                       
G0503004004qualified health care professional, with the following required elements:                                                                                                                                                                                                                                            
G0503005004tracking patient follow-up and progress using the registry, with appropriate                                                                                                                                                                                                                                         
G0503006004documentation;  participation in weekly caseload consultation with the                                                                                                                                                                                                                                               
G0503007004psychiatric consultant;  ongoing collaboration with and coordination of the                                                                                                                                                                                                                                          
G0503008004patient's mental health care with the treating physician or other qualified                                                                                                                                                                                                                                          
G0503009004health care professional and any other treating mental health providers;                                                                                                                                                                                                                                             
G0503010004additional review of progress and recommendations for changes in treatment, as                                                                                                                                                                                                                                       
G0503011004indicated, including medications, based on recommendations provided by the                                                                                                                                                                                                                                           
G0503012004psychiatric consultant;  provision of brief interventions using evidence-based                                                                                                                                                                                                                                       
G0503013004techniques such as behavioral activation, motivational interviewing, and other                                                                                                                                                                                                                                       
G0503014004focused treatment strategies;  monitoring of patient outcomes using validated                                                                                                                                                                                                                                        
G0503015004rating scales; and relapse prevention planning with patients as they achieve                                                                                                                                                                                                                                         
G0503016004remission of symptoms and/or other treatment goals and are prepared for                                                                                                                                                                                                                                              
G0503017004discharge from active treatment                                                                                                                                                                                                                                                                                      
G0504001003Initial or subsequent psychiatric collaborative care management, each           Init/sub psych care add 30 m13      A                                                                            99494                    C                          M5D 1      0201701012018010120171231N                           
G0504002004additional 30 minutes in a calendar month of behavioral health care manager                                                                                                                                                                                                                                          
G0504003004activities, in consultation with a psychiatric consultant, and directed by the                                                                                                                                                                                                                                       
G0504004004treating physician or other qualified health care professional (list separately                                                                                                                                                                                                                                      
G0504005004in addition to code for primary procedure);  (use g0504 in conjunction with                                                                                                                                                                                                                                          
G0504006004g0502, g0503)                                                                                                                                                                                                                                                                                                        
G0505001003Cognition and functional assessment using standardized instruments with         Cog/func assessment  outpt  13      A                                                                            99483                    C                          M5D 1      0201701012018010120171231N                           
G0505002004development of recorded care plan for the patient with cognitive impairment,                                                                                                                                                                                                                                         
G0505003004history obtained from patient and/or caregiver, in office or other outpatient                                                                                                                                                                                                                                        
G0505004004setting or home or domiciliary or rest home                                                                                                                                                                                                                                                                          
G0506001003Comprehensive assessment of and care planning for patients requiring chronic    Comp asses care plan ccm svc13      A                                                                                                     C                          M5D 1      02017010120170101        N                           
G0506002004care management services (list separately in addition to primary monthly care                                                                                                                                                                                                                                        
G0506003004management service)                                                                                                                                                                                                                                                                                                  
G0507001003Care management services for behavioral health conditions, at least 20 minutes  Care manage serv minimum 20 13      A                                                                            99484                    C                          M5D 1      0201701012018010120171231N                           
G0507002004of clinical staff time, directed by a physician or other qualified health care                                                                                                                                                                                                                                       
G0507003004professional, per calendar month, with the following required elements: initial                                                                                                                                                                                                                                      
G0507004004assessment or follow-up monitoring, including the use of applicable validated                                                                                                                                                                                                                                        
G0507005004rating scales; behavioral health care planning in relation to                                                                                                                                                                                                                                                        
G0507006004behavioral/psychiatric health problems, including revision for patients who are                                                                                                                                                                                                                                      
G0507007004not progressing or whose status changes; facilitating and coordinating                                                                                                                                                                                                                                               
G0507008004treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric                                                                                                                                                                                                                                      
G0507009004consultation; and continuity of care with a designated member of the care team                                                                                                                                                                                                                                       
G0508001003Telehealth consultation, critical care, initial , physicians typically spend 60 Crit care telehea consult 6013      A                                                                                                     C                          M5D 1      02017010120170101        N                           
G0508002004minutes communicating with the patient and providers via telehealth                                                                                                                                                                                                                                                  
G0509001003Telehealth consultation, critical care, subsequent, physicians typically spend  Crit care telehea consult 5013      A                                                                                                     C                          M5D 1      02017010120170101        N                           
G050900200450 minutes communicating with the patient and providers via telehealth                                                                                                                                                                                                                                               
G0511001003Rural health clinic or federally qualified health center (rhc or fqhc) only,    Ccm/bhi by rhc/fqhc 20min mo13      A                                                                                                     D                      0214M5D 1      02018010120180101        N                           
G0511002004general care management, 20 minutes or more of clinical staff time for chronic                                                                                                                                                                                                                                       
G0511003004care management services or behavioral health integration services directed by                                                                                                                                                                                                                                       
G0511004004an rhc or fqhc practitioner (physician, np, pa, or cnm), per calendar month                                                                                                                                                                                                                                          
G0512001003Rural health clinic or federally qualified health center (rhc/fqhc) only,       Cocm by rhc/fqhc 60 min mo  13      A                                                                                                     D                      0214M5D 1      02018010120180101        N                           
G0512002004psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of                                                                                                                                                                                                                                       
G0512003004clinical staff time for psychiatric cocm services directed by an rhc or fqhc                                                                                                                                                                                                                                         
G0512004004practitioner (physician, np, pa, or cnm) and including services furnished by a                                                                                                                                                                                                                                       
G0512005004behavioral health care manager and consultation with a psychiatric consultant,                                                                                                                                                                                                                                       
G0512006004per calendar month                                                                                                                                                                                                                                                                                                   
G0513001003Prolonged preventive service(s) (beyond the typical service time of the primary Prolong prev svcs, first 30m13      A                                                                                                     C                          M5D 1      02018010120180101        N                           
G0513002004procedure), in the office or other outpatient setting requiring direct patient                                                                                                                                                                                                                                       
G0513003004contact beyond the usual service; first 30 minutes (list separately in addition                                                                                                                                                                                                                                      
G0513004004to code for preventive service)                                                                                                                                                                                                                                                                                      
G0514001003Prolonged preventive service(s) (beyond the typical service time of the primary Prolong prev svcs, addl 30m 13      A                                                                                                     C                          M5D 1      02018010120180101        N                           
G0514002004procedure), in the office or other outpatient setting requiring direct patient                                                                                                                                                                                                                                       
G0514003004contact beyond the usual service; each additional 30 minutes (list separately                                                                                                                                                                                                                                        
G0514004004in addition to code g0513 for additional 30 minutes of preventive service)                                                                                                                                                                                                                                           
G0515001003Development of cognitive skills to improve attention, memory, problem solving   Cognitive skills development11      A                                                                                                     C                          M5D 1      02018010120180101        N                           
G0515002004(includes compensatory training), direct (one-on-one) patient contact, each 15                                                                                                                                                                                                                                       
G0515003004minutes                                                                                                                                                                                                                                                                                                              
G0516001003Insertion of non-biodegradable drug delivery implants, 4 or more (services for  Insert drug del implant, >=413      A                                                                                                     C                          P6C 1      02018010120180401        S                           
G0516002004subdermal rod implant)                                                                                                                                                                                                                                                                                               
G0517001003Removal of non-biodegradable drug delivery implants, 4 or more (services for    Remove drug implant         13      A                                                                                                     C                          P6C 1      02018010120180101        N                           
G0517002004subdermal implants)                                                                                                                                                                                                                                                                                                  
G0518001003Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more   Remove w insert drug implant13      A                                                                                                     C                          P6C 1      02018010120180101        N                           
G0518002004(services for subdermal implants)                                                                                                                                                                                                                                                                                    
G0659001003Drug test(s), definitive, utilizing drug identification methods able to         Drug test def simple all cl 21      A                                                    340                                              C                          T1H 5      02017010120170101        N                           
G0659002004identify individual drugs and distinguish between structural isomers (but not                                                                                                                                                                                                                                        
G0659003004necessarily stereoisomers), including but not limited to gc/ms (any type,                                                                                                                                                                                                                                            
G0659004004single or tandem) and lc/ms (any type, single or tandem), excluding                                                                                                                                                                                                                                                  
G0659005004immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g.,                                                                                                                                                                                                                                         
G0659006004alcohol dehydrogenase), performed without method or drug-specific calibration,                                                                                                                                                                                                                                       
G0659007004without matrix-matched quality control material, or without use of stable                                                                                                                                                                                                                                            
G0659008004isotope or other universally recognized internal standard(s) for each drug,                                                                                                                                                                                                                                          
G0659009004drug metabolite or drug class per specimen; qualitative or quantitative, all                                                                                                                                                                                                                                         
G0659010004sources, includes specimen validity testing, per day, any number of drug classes                                                                                                                                                                                                                                     
G0908001003Most recent hemoglobin (hgb) level > 12.0 g/dl                                  Hgb > 12 g/dl               00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0909001003Hemoglobin level measurement not documented, reason not given                   Hbg not doc                 00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0910001003Most recent hemoglobin level <= 12.0 g/dl                                       Hgb <= 12 g/dl              00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0913001003Improvement in visual function achieved within 90 days following cataract       Improve visual funct        00      9                                                                                                     C                          M5D 1      02012010120120101        N                           
G0913002004surgery                                                                                                                                                                                                                                                                                                              
G0914001003Patient care survey was not completed by patient                                Survey not complete         00      9                                                                                                     C                          M5D 1      02012010120120101        N                           
G0915001003Improvement in visual function not achieved within 90 days following cataract   No improve visual funct     00      9                                                                                                     C                          M5D 1      02012010120120101        N                           
G0915002004surgery                                                                                                                                                                                                                                                                                                              
G0916001003Satisfaction with care achieved within 90 days following cataract surgery       Satisfy with care           00      9                                                                                                     C                          M5D 1      02012010120120101        N                           
G0917001003Patient satisfaction survey was not completed by patient                        Satisfy survey not complete 00      9                                                                                                     C                          M5D 1      02012010120120101        N                           
G0918001003Satisfaction with care not achieved within 90 days following cataract surgery   No satisfy with care        00      9                                                                                                     C                          M5D 1      02012010120120101        N                           
G0919001003Influenza immunization ordered or recommended (to be given at alternate         Flu immunize not avail      00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0919002004location or alternate provider); vaccine not available at time of visit                                                                                                                                                                                                                                              
G0920001003Type, anatomic location, and activity all documented                            Type loc act doc            00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0921001003Documentation of patient reason(s) for not being able to assess (e.g., patient  Doc pt reas no assess       00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0921002004refuses endoscopic and/or radiologic assessment)                                                                                                                                                                                                                                                                     
G0922001003No documentation of disease type, anatomic location, and activity, reason not   Type loc act not doc        00      9                                                                                                     C                          M5D 1      0201201012015010120141231N                           
G0922002004given                                                                                                                                                                                                                                                                                                                
G2000001003Blinded administration of convulsive therapy procedure, either                  Blinded conv. tx mdd clin tr00      9                                                                                                     C                          P6D 1      02018080120180801        A                           
G2000002004electroconvulsive therapy (ect, current covered gold standard) or magnetic                                                                                                                                                                                                                                           
G2000003004seizure therapy (mst, non-covered experimental therapy), performed in an                                                                                                                                                                                                                                             
G2000004004approved ide-based clinical trial, per treatment session                                                                                                                                                                                                                                                             
G2010001003Remote evaluation of recorded video and/or images submitted by an established   Remot image submit by pt    13      A                                                                                                     C                          M5D 1      02019010120190101        A                           
G2010002004patient (e.g., store and forward), including interpretation with follow-up with                                                                                                                                                                                                                                      
G2010003004the patient within 24 business hours, not originating from a related e/m                                                                                                                                                                                                                                             
G2010004004service provided within the previous 7 days nor leading to an e/m service or                                                                                                                                                                                                                                         
G2010005004procedure within the next 24 hours or soonest available appointment                                                                                                                                                                                                                                                  
G2011001003Alcohol and/or substance (other than tobacco) abuse structured assessment       Alcohol/sub abuse assess    13      A                                                                                                     C                          M1B 1      02019010120190101        A                           
G2011002004(e.g., audit, dast), and brief intervention, 5-14 minutes                                                                                                                                                                                                                                                            
G2012001003Brief communication technology-based service, e.g. virtual check-in, by a       Brief check in by md/qhp    13      A                                                                                                     C                          M5D 1      02019010120190101        A                           
G2012002004physician or other qualified health care professional who can report evaluation                                                                                                                                                                                                                                      
G2012003004and management services, provided to an established patient, not originating                                                                                                                                                                                                                                         
G2012004004from a related e/m service provided within the previous 7 days nor leading to                                                                                                                                                                                                                                        
G2012005004an e/m service or procedure within the next 24 hours or soonest available                                                                                                                                                                                                                                            
G2012006004appointment; 5-10 minutes of medical discussion                                                                                                                                                                                                                                                                      
G3001001003Administration and supply of tositumomab, 450 mg                                Admin + supply, tositumomab 13      A                                                                                                     C                          T2D 1      0200307012017010120161231N                           
G6001001003Ultrasonic guidance for placement of radiation therapy fields                   Echo guidance radiotherapy  13      A50-7                                                                                                 D                          I3F 6      02015010120150101        N                           
G6002001003Stereoscopic x-ray guidance for localization of target volume for the delivery  Stereoscopic x-ray guidance 13      A                                                                                                     C                          I4B 6      02015010120150101        N                           
G6002002004of radiation therapy                                                                                                                                                                                                                                                                                                 
G6003001003Radiation treatment delivery, single treatment area,single port or parallel     Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6003002004opposed ports, simple blocks or no blocks: up to 5 mev                                                                                                                                                                                                                                                               
G6004001003Radiation treatment delivery, single treatment area,single port or parallel     Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6004002004opposed ports, simple blocks or no blocks: 6-10 mev                                                                                                                                                                                                                                                                  
G6005001003Radiation treatment delivery, single treatment area,single port or parallel     Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6005002004opposed ports, simple blocks or no blocks: 11-19 mev                                                                                                                                                                                                                                                                 
G6006001003Radiation treatment delivery, single treatment area,single port or parallel     Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6006002004opposed ports, simple blocks or no blocks: 20 mev or greater                                                                                                                                                                                                                                                         
G6007001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a  Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6007002004single treatment area, use of multiple blocks: up to 5 mev                                                                                                                                                                                                                                                           
G6008001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a  Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6008002004single treatment area, use of multiple blocks: 6-10 mev                                                                                                                                                                                                                                                              
G6009001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a  Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6009002004single treatment area, use of multiple blocks: 11-19 mev                                                                                                                                                                                                                                                             
G6010001003Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a  Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6010002004single treatment area, use of multiple blocks: 20 mev or greater                                                                                                                                                                                                                                                     
G6011001003Radiation treatment delivery,3 or more separate treatment areas, custom         Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6011002004blocking, tangential ports, wedges, rotational beam, compensators, electron                                                                                                                                                                                                                                          
G6011003004beam; up to 5 mev                                                                                                                                                                                                                                                                                                    
G6012001003Radiation treatment delivery,3 or more separate treatment areas, custom         Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6012002004blocking, tangential ports, wedges, rotational beam, compensators, electron                                                                                                                                                                                                                                          
G6012003004beam; 6-10 mev                                                                                                                                                                                                                                                                                                       
G6013001003Radiation treatment delivery,3 or more separate treatment areas, custom         Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6013002004blocking, tangential ports, wedges, rotational beam, compensators, electron                                                                                                                                                                                                                                          
G6013003004beam; 11-19 mev                                                                                                                                                                                                                                                                                                      
G6014001003Radiation treatment delivery,3 or more separate treatment areas, custom         Radiation treatment delivery13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6014002004blocking, tangential ports, wedges, rotational beam, compensators, electron                                                                                                                                                                                                                                          
G6014003004beam; 20 mev or greater                                                                                                                                                                                                                                                                                              
G6015001003Intensity modulated treatment delivery, single or multiple fields/arcs,via      Radiation tx delivery imrt  13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6015002004narrow spatially and temporally modulated beams, binary, dynamic mlc, per                                                                                                                                                                                                                                            
G6015003004treatment session                                                                                                                                                                                                                                                                                                    
G6016001003Compensator-based beam modulation treatment delivery of inverse planned         Delivery comp imrt          13      A                                                                                                     C                          P7A 6      02015010120150101        N                           
G6016002004treatment using 3 or more high resolution (milled or cast) compensator,                                                                                                                                                                                                                                              
G6016003004convergent beam modulated fields, per treatment session                                                                                                                                                                                                                                                              
G6017001003Intra-fraction localization and tracking of target or patient motion during     Intrafraction track motion  13      A                                                                                                     C                          P6C 6      02015010120150101        N                           
G6017002004delivery of radiation therapy (eg,3d positional tracking, gating, 3d surface                                                                                                                                                                                                                                         
G6017003004tracking), each fraction of treatment                                                                                                                                                                                                                                                                                
G6018001003Ileoscopy, through stoma; with transendoscopic stent placement (includes        Ileoscopy w/stent           13      A                                                                                                     C                          P8I 2      0201501012016010120151231N                           
G6018002004predilation)                                                                                                                                                                                                                                                                                                         
G6019001003Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other        Colonoscopy lesion removal  13      A                                                                                                     C                          P8D 2      0201501012016010120151231N                           
G6019002004lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or                                                                                                                                                                                                                                          
G6019003004snare technique                                                                                                                                                                                                                                                                                                      
G6020001003Colonoscopy through stoma; with transendoscopic stent placement (includes       Colonoscopy w/stent         13      A                                                                                                     C                          P8D 2      0201501012016010120151231N                           
G6020002004predilation)                                                                                                                                                                                                                                                                                                         
G6021001003Unlisted procedure, intestine                                                   Unlisted px small intestine 13      A                                                                                                     C                          P1G 2      0201501012016010120151231N                           
G6022001003Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other          Sigmoidoscopy w/ablate tumr 13      A                                                                                                     C                          P8C 2      0201501012016010120151231N                           
G6022002004lesions(s) not amenable to removal by hot biopsy forceps, bipolar cautery or                                                                                                                                                                                                                                         
G6022003004snare technique                                                                                                                                                                                                                                                                                                      
G6023001003Sigmoidoscopy, flexible; with transendoscopic stent placement (includes         Sigmoidoscopy w/stent       13      A                                                                                                     C                          P8C 2      0201501012016010120151231N                           
G6023002004predilation)                                                                                                                                                                                                                                                                                                         
G6024001003Colonoscopy, flexible; proximal to splenic flexure; with ablation of tumor(s),  Lesion removal colonoscopy  13      A                                                                                                     C                          P8D 2      0201501012016010120151231N                           
G6024002004polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps,                                                                                                                                                                                                                                          
G6024003004bipolar cautery or snare technique                                                                                                                                                                                                                                                                                   
G6025001003Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent  Colonoscopy w/stent         13      A                                                                                                     C                          P8D 2      0201501012016010120151231N                           
G6025002004placement (includes predilation)                                                                                                                                                                                                                                                                                     
G6027001003Anoscopy, high resolution (hra) (with magnification and chemical agent          Anoscopy hra w/spec collect 13      A                                                                                                     C                          P5E 2      0201501012016010120151231N                           
G6027002004enhancement); diagnostic, including collection of specimen(s) by brushing or                                                                                                                                                                                                                                         
G6027003004washing when performed                                                                                                                                                                                                                                                                                               
G6028001003Anoscopy, high resolution (hra) (with magnification and chemical agent          Anoscopy hra w/biopsy       13      A                                                                                                     C                          P5E 2      0201501012016010120151231N                           
G6028002004enhancement); with biopsy(ies)                                                                                                                                                                                                                                                                                       
G6030001003Amitriptyline                                                                   Assay of amitriptyline      21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6031001003Benzodiazepines                                                                 Assay of benzodiazepines    21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6032001003Desipramine                                                                     Assay of desipramine        21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6034001003Doxepin                                                                         Assay of doxepin            21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6035001003Gold                                                                            Assay of gold               21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6036001003Assay of imipramine                                                             Assay of imipramine         21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6037001003Nortriptyline                                                                   Assay of nortiptyline       21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6038001003Salicylate                                                                      Assay of salicylate         21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6039001003Acetaminophen                                                                   Assay of acetaminophen      21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6040001003Alcohol (ethanol); any specimen except breath                                   Assay of ethanol            21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6041001003Alkaloids, urine, quantitative                                                  Assay of urine alkaloids    21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6042001003Amphetamine or methamphetamine                                                  Assay of amphetamines       21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6043001003Barbiturates, not elsewhere specified                                           Assay of barbiturates       21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6044001003Cocaine or metabolite                                                           Assay of cocaine            21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6045001003Dihydrocodeinone                                                                Assay of dihydrocodeinone   21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6046001003Dihydromorphinone                                                               Assay of dihydromorphinone  21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6047001003Dihydrotestosterone                                                             Assay of dihydrotestosterone21      A                                                    330                                              C                          T1H 5      0201501012016010120151231N                           
G6048001003Dimethadione                                                                    Assay of dimethadione       21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6049001003Epiandrosterone                                                                 Asssay of epiandrosterone   21      A                                                    330                                              C                          T1H 5      0201501012016010120151231N                           
G6050001003Ethchlorvynol                                                                   Assay of ethchlorvynol      21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6051001003Flurazepam                                                                      Assay of flurazepam         21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6052001003Meprobamate                                                                     Assay of meprobamate        21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6053001003Methadone                                                                       Assay of methadone          21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6054001003Methsuximide                                                                    Assay of methsuximide       21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6055001003Nicotine                                                                        Assay of nicotine           21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6056001003Opiate(s), drug and metabolites, each procedure                                 Assay of opiates            21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6057001003Phenothiazine                                                                   Assay of phenothiazine      21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G6058001003Drug confirmation, each procedure                                               Drug confirmation           21      A                                                    340                                              C                          T1H 5      0201501012016010120151231N                           
G8126001003Patient with a diagnosis of major depression documented as being treated with   Pt treat w/antidepress12wks 00      9                                                                                                     C                          M5D 1      0200601012015010120141231N                           
G8126002004antidepressant medication during the entire 84 day (12 week)  acute treatment                                                                                                                                                                                                                                        
G8126003004phase                                                                                                                                                                                                                                                                                                                
G8127001003Patient with a diagnosis of major depression not documented as being treated    Pt not treat w/antidepres12w00      9                                                                                                     C                          M5D 1      0200601012015010120141231N                           
G8127002004with antidepressant medication during the entire 84 day (12 week) acute                                                                                                                                                                                                                                              
G8127003004treatment phase                                                                                                                                                                                                                                                                                                      
G8128001003Clinician documented that patient was not an eligible candidate for             Pt inelig for antidepres med00      9                                                                                                     C                          M5D 1      0200601012015010120141231N                           
G8128002004antidepressant medication during the entire 12 week acute treatment phase                                                                                                                                                                                                                                            
G8128003004measure                                                                                                                                                                                                                                                                                                              
G8395001003Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or  Lvef>=40% doc normal or mild00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8395002004mildly depressed left ventricular systolic function                                                                                                                                                                                                                                                                  
G8396001003Left ventricular ejection fraction (lvef) not performed or documented           Lvef not performed          00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8397001003Dilated macular or fundus exam performed, including documentation of the        Dil macula/fundus exam/w doc00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8397002004presence or absence of macular edema and level of severity of retinopathy                                                                                                                                                                                                                                            
G8398001003Dilated macular or fundus exam not performed                                    Dil macular/fundus not perfo00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8399001003Patient with documented results of a central dual-energy x-ray absorptiometry   Pt w/dxa results document   00      9                                                                                                     C                          M5D 1      02008010120160101        N                           
G8399002004(dxa) ever being performed                                                                                                                                                                                                                                                                                           
G8400001003Patient with central dual-energy x-ray absorptiometry (dxa) results not         Pt w/dxa no results doc     00      9                                                                                                     C                          M5D 1      02008010120160101        N                           
G8400002004documented, reason not given                                                                                                                                                                                                                                                                                         
G8401001003Clinician documented that patient was not an eligible candidate for screening   Pt inelig osteo screen measu00      9                                                                                                     C                          M5D 1      0200801012017010120161231N                           
G8404001003Lower extremity neurological exam performed and documented                      Low extemity neur exam docum00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8405001003Lower extremity neurological exam not performed                                 Low extemity neur not perfor00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8406001003Clinician documented that patient was not an eligible candidate for lower       Pt inelig lower extrem neuro00      9                                                                                                     C                          M5D 1      0200801012015010120141231N                           
G8406002004extremity neurological exam measure                                                                                                                                                                                                                                                                                  
G8410001003Footwear evaluation performed and documented                                    Eval on foot documented     00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8415001003Footwear evaluation was not performed                                           Eval on foot not performed  00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8416001003Clinician documented that patient was not an eligible candidate for footwear    Pt inelig footwear evaluatio00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8416002004evaluation measure                                                                                                                                                                                                                                                                                                   
G8417001003Bmi is documented above normal parameters and a follow-up plan is documented    Calc bmi abv up param f/u   00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8418001003Bmi is documented below normal parameters and a follow-up plan is documented    Calc bmi blw low param f/u  00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8419001003Bmi documented outside normal parameters, no follow-up plan documented, no      Calc bmi out nrm param nof/u00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8419002004reason given                                                                                                                                                                                                                                                                                                         
G8420001003Bmi is documented within normal parameters and no follow-up plan is required    Calc bmi norm parameters    00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8421001003Bmi not documented and no reason is given                                       Bmi not calculated          00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8422001003Bmi not documented, documentation the patient is not eligible for bmi           Pt inelig bmi calculation   00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8422002004calculation                                                                                                                                                                                                                                                                                                          
G8427001003Eligible clinician attests to documenting in the medical record they obtained,  Docrev cur meds by elig clin00      9                                                                                                     C                          M5D 1      02008010120170101        N                           
G8427002004updated, or reviewed the patient's current medications                                                                                                                                                                                                                                                               
G8428001003Current list of medications not documented as obtained, updated, or reviewed by Cur meds not document       00      9                                                                                                     C                          M5D 1      02008010120170101        N                           
G8428002004the eligible clinician, reason not given                                                                                                                                                                                                                                                                             
G8430001003Eligible clinician attests to documenting in the medical record the patient is  Ec at doc medrec pt not elig00      9                                                                                                     C                          M5D 1      02008010120180101        N                           
G8430002004not eligible for a current list of medications being obtained, updated, or                                                                                                                                                                                                                                           
G8430003004reviewed by the eligible clinician                                                                                                                                                                                                                                                                                   
G8431001003Screening for depression is documented as being positive and a follow-up plan   Pos clin depres scrn f/u doc00      9                                                                                                     C                          M5D 1      02008010120170101        N                           
G8431002004is documented                                                                                                                                                                                                                                                                                                        
G8432001003Depression screening not documented, reason not given                           Dep scr not doc, rng        00      9                                                                                                     C                          M5D 1      02008010120170101        N                           
G8433001003Screening for depression not completed, documented reason                       Scr for dep not cpt doc rsn 00      9                                                                                                     C                          M5D 1      02008010120180101        N                           
G8442001003Pain assessment not documented as being performed, documentation the patient is Doc pain as nt perf, not elg00      9                                                                                                     C                          M5D 1      02008010120180101        N                           
G8442002004not eligible for a pain assessment using a standardized tool at the time of the                                                                                                                                                                                                                                      
G8442003004encounter                                                                                                                                                                                                                                                                                                            
G8450001003Beta-blocker therapy prescribed                                                 Beta-bloc rx pt w/abn lvef  00      9                                                                                                     C                          M5D 1      02008010120130101        N                           
G8451001003Beta-blocker therapy for lvef < 40% not prescribed for reasons documented by    Pt w/abn lvef inelig b-bloc 00      9                                                                                                     C                          M5D 1      02008010120140101        N                           
G8451002004the clinician (e.g., low blood pressure, fluid overload, asthma, patients                                                                                                                                                                                                                                            
G8451003004recently treated with an intravenous positive inotropic agent, allergy,                                                                                                                                                                                                                                              
G8451004004intolerance, other medical reasons, patient declined, other patient reasons, or                                                                                                                                                                                                                                      
G8451005004other reasons attributable to the healthcare system)                                                                                                                                                                                                                                                                 
G8452001003Beta-blocker therapy not prescribed                                             Pt w/abn lvef b-bloc no rx  00      9                                                                                                     C                          M5D 1      02008010120130101        N                           
G8458001003Clinician documented that patient is not an eligible candidate for genotype     Pt inelig geno no antvir tx 00      9                                                                                                     C                          M5D 1      0200801012017010120161231N                           
G8458002004testing; patient not receiving antiviral treatment for hepatitis c during the                                                                                                                                                                                                                                        
G8458003004measurement period (e.g. genotype test done prior to the reporting period,                                                                                                                                                                                                                                           
G8458004004patient declines, patient not a candidate for antiviral treatment)                                                                                                                                                                                                                                                   
G8460001003Clinician documented that patient is not an eligible candidate for quantitative Pt inelig rna no antvir tx  00      9                                                                                                     C                          M5D 1      0200801012017010120161231N                           
G8460002004rna testing at week 12; patient not receiving antiviral treatment for hepatitis                                                                                                                                                                                                                                      
G8460003004c                                                                                                                                                                                                                                                                                                                    
G8461001003Patient receiving antiviral treatment for hepatitis c during the measurement    Pt rec antivir treat hep c  00      9                                                                                                     C                          M5D 1      0200801012017010120161231N                           
G8461002004period                                                                                                                                                                                                                                                                                                               
G8464001003Clinician documented that prostate cancer patient is not an eligible candidate  Pt inelig; lo to no dter rsk00      9                                                                                                     C                          M5D 1      0200801012015010120141231N                           
G8464002004for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk                                                                                                                                                                                                                                        
G8464003004of recurrence not determined                                                                                                                                                                                                                                                                                         
G8465001003High or very high risk of recurrence of prostate cancer                         High risk recurrence pro ca 00      9                                                                                                     C                          M5D 1      02008010120160101        N                           
G8473001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   Ace/arb thxpy rx'd          00      9                                                                                                     C                          M5D 1      02008010120080101        N                           
G8473002004(arb) therapy prescribed                                                                                                                                                                                                                                                                                             
G8474001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   Ace/arb not rx'd; doc reas  00      9                                                                                                     C                          M5D 1      02008010120150101        N                           
G8474002004(arb) therapy not prescribed for reasons documented by the clinician (e.g.,                                                                                                                                                                                                                                          
G8474003004allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases                                                                                                                                                                                                                                        
G8474004004of the aortic or mitral valve, other medical reasons) or (e.g., patient                                                                                                                                                                                                                                              
G8474005004declined, other patient reasons) or (e.g., lack of drug availability, other                                                                                                                                                                                                                                          
G8474006004reasons attributable to the health care system)                                                                                                                                                                                                                                                                      
G8475001003Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker   Ace/arb thxpy not rx'd      00      9                                                                                                     C                          M5D 1      02008010120130101        N                           
G8475002004(arb) therapy not prescribed, reason not given                                                                                                                                                                                                                                                                       
G8476001003Most recent blood pressure has a systolic measurement of < 140 mmhg and a       Bp sys <140 and dias <90    00      9                                                                                                     C                          M5D 1      02008010120150101        N                           
G8476002004diastolic measurement of < 90 mmhg                                                                                                                                                                                                                                                                                   
G8477001003Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a   Bp sys>=140 and/or dias >=9000      9                                                                                                     C                          M5D 1      02008010120150101        N                           
G8477002004diastolic measurement of >= 90 mmhg                                                                                                                                                                                                                                                                                  
G8478001003Blood pressure measurement not performed or documented, reason not given        Bp not performed/doc        00      9                                                                                                     C                          M5D 1      02008010120130101        N                           
G8482001003Influenza immunization administered or previously received                      Flu immunize order/admin    00      9                                                                                                     C                          M5D 1      02008010120120101        N                           
G8483001003Influenza immunization was not administered for reasons documented by clinician Flu imm no admin doc rea    00      9                                                                                                     C                          M5D 1      02008010120150101        N                           
G8483002004(e.g., patient allergy or other medical reasons, patient declined or other                                                                                                                                                                                                                                           
G8483003004patient reasons, vaccine not available or other system reasons)                                                                                                                                                                                                                                                      
G8484001003Influenza immunization was not administered, reason not given                   Flu immunize no admin       00      9                                                                                                     C                          M5D 1      02008010120150101        N                           
G8485001003I intend to report the diabetes mellitus (dm) measures group                    Report, diabetes measures   00      9                                                                                                     C                          M5D 1      0200807012017010120161231N                           
G8486001003I intend to report the preventive care measures group                           Report, prev care measures  00      9                                                                                                     C                          M5D 1      0200807012017010120161231N                           
G8487001003I intend to report the chronic kidney disease (ckd) measures group              Report ckd measures         00      9                                                                                                     C                          M5D 1      0200807012017010120161231N                           
G8489001003I intend to report the coronary artery disease (cad) measures group             Cad measures grp            00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8490001003I intend to report the rheumatoid arthritis (ra) measures group                 Ra measures grp             00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8491001003I intend to report the hiv/aids measures group                                  Hiv/aids measures grp       00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8492001003I intend to report the perioperative care measures group                        Periop care measures grp    00      9                                                                                                     C                          M5D 1      0200901012015010120141231N                           
G8493001003I intend to report the back pain measures group                                 Back pain measures grp      00      9                                                                                                     C                          M5D 1      0200901012015010120141231N                           
G8494001003All quality actions for the applicable measures in the diabetes mellitus (dm)   Dm meas qual act perform    00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8494002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G8495001003All quality actions for the applicable measures in the chronic kidney disease   Ckd meas qual act perform   00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8495002004(ckd) measures group have been performed for this patient                                                                                                                                                                                                                                                            
G8496001003All quality actions for the applicable measures in the preventive care measures Prev care mg qual act perfrm00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8496002004group have been performed for this patient                                                                                                                                                                                                                                                                           
G8497001003All quality actions for the applicable measures in the coronary artery bypass   Cabg meas qual act perform  00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8497002004graft (cabg) measures group have been performed for this patient                                                                                                                                                                                                                                                     
G8498001003All quality actions for the applicable measures in the coronary artery disease  Cad meas qual act perform   00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8498002004(cad) measures group have been performed for this patient                                                                                                                                                                                                                                                            
G8499001003All quality actions for the applicable measures in the rheumatoid arthritis     Ra meas qual act perform    00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8499002004(ra) measures group have been performed for this patient                                                                                                                                                                                                                                                             
G8500001003All quality actions for the applicable measures in the hiv/aids measures group  Hiv meas qual act perform   00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8500002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G8501001003All quality actions for the applicable measures in the perioperative care       Perio meas qual act perform 00      9                                                                                                     C                          M5D 1      0200901012015010120141231N                           
G8501002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G8502001003All quality actions for the applicable measures in the back pain measures group Back pain mg qual act perfrm00      9                                                                                                     C                          M5D 1      0200901012015010120141231N                           
G8502002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G8506001003Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin  Pt rec ace/arb              00      9                                                                                                     C                          M5D 1      02009010120090101        N                           
G8506002004receptor blocker (arb) therapy                                                                                                                                                                                                                                                                                       
G8509001003Pain assessment documented as positive using a standardized tool, follow-up     Pos pain assess no f/u doc  00      9                                                                                                     C                          M5D 1      02009010120140101        N                           
G8509002004plan not documented, reason not given                                                                                                                                                                                                                                                                                
G8510001003Screening for depression is documented as negative, a follow-up plan is not     Scr dep neg, no plan reqd   00      9                                                                                                     C                          M5D 1      02009010120170101        N                           
G8510002004required                                                                                                                                                                                                                                                                                                             
G8511001003Screening for depression documented as positive, follow-up plan not documented, Scr dep pos, no plan doc rng00      9                                                                                                     C                          M5D 1      02009010120170101        N                           
G8511002004reason not given                                                                                                                                                                                                                                                                                                     
G8530001003Autogenous av fistula received                                                  Auto av fistula recd        00      9                                                                                                     C                          M5D 1      0200901012016010120151231N                           
G8531001003Clinician documented that patient was not an eligible candidate for autogenous  Pt inelig; auto av fistula  00      9                                                                                                     C                          M5D 1      0200901012016010120151231N                           
G8531002004av fistula                                                                                                                                                                                                                                                                                                           
G8532001003Clinician documented that patient received vascular access other than           No auto av fistula; no reas 00      9                                                                                                     C                          M5D 1      0200901012016010120151231N                           
G8532002004autogenous av fistula, reason not given                                                                                                                                                                                                                                                                              
G8535001003Elder maltreatment screen not documented; documentation that patient is not     Eld maltreatment not doc    00      9                                                                                                     C                          M5D 1      02009010120180101        N                           
G8535002004eligible for the elder maltreatment screen at the time of the encounter                                                                                                                                                                                                                                              
G8536001003No documentation of an elder maltreatment screen, reason not given              No doc elder mal scrn       00      9                                                                                                     C                          M5D 1      02009010120130101        N                           
G8539001003Functional outcome assessment documented as positive using a standardized tool  Doc funct and care plan     00      9                                                                                                     C                          M5D 1      02009010120140101        N                           
G8539002004and a care plan based on identified deficiencies on the date of functional                                                                                                                                                                                                                                           
G8539003004outcome assessment, is documented                                                                                                                                                                                                                                                                                    
G8540001003Functional outcome assessment not documented as being performed, documentation  Foa not doc as being perf   00      9                                                                                                     C                          M5D 1      02009010120180101        N                           
G8540002004the patient is not eligible for a functional outcome assessment using a                                                                                                                                                                                                                                              
G8540003004standardized tool at the time of the encounter                                                                                                                                                                                                                                                                       
G8541001003Functional outcome assessment using a standardized tool not documented, reason  No doc cur funct assess     00      9                                                                                                     C                          M5D 1      02009010120130101        N                           
G8541002004not given                                                                                                                                                                                                                                                                                                            
G8542001003Functional outcome assessment using a standardized tool is documented; no       Doc funct no deficiencies   00      9                                                                                                     C                          M5D 1      02009010120140101        N                           
G8542002004functional deficiencies identified, care plan not required                                                                                                                                                                                                                                                           
G8543001003Documentation of a positive functional outcome assessment using a standardized  Cur funct asses; no care pln00      9                                                                                                     C                          M5D 1      02009010120140101        N                           
G8543002004tool; care plan not documented, reason not given                                                                                                                                                                                                                                                                     
G8544001003I intend to report the coronary artery bypass graft (cabg) measures group       Cabg measures grp           00      9                                                                                                     C                          M5D 1      0200901012017010120161231N                           
G8545001003I intend to report the hepatitis c measures group                               Hepc measures grp           00      9                                                                                                     C                          M5D 1      0201001012017010120161231N                           
G8547001003I intend to report the ischemic vascular disease (ivd) measures group           Ivd measures grp            00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8548001003I intend to report the heart failure (hf) measures group                        Hf measures grp             00      9                                                                                                     C                          M5D 1      0201001012017010120161231N                           
G8549001003All quality actions for the applicable measures in the hepatitis c measures     Hepc mg qual act perform    00      9                                                                                                     C                          M5D 1      0201001012017010120161231N                           
G8549002004group have been performed for this patient                                                                                                                                                                                                                                                                           
G8551001003All quality actions for the applicable measures in the heart failure (hf)       Hf mg qual act perform      00      9                                                                                                     C                          M5D 1      0201001012017010120161231N                           
G8551002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G8552001003All quality actions for the applicable measures in the ischemic vascular        Ivd mg qual act perform     00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8552002004disease (ivd) measures group have been performed for this patient                                                                                                                                                                                                                                                    
G8559001003Patient referred to a physician (preferably a physician with training in        Pt ref doc oto eval         00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8559002004disorders of the ear) for an otologic evaluation                                                                                                                                                                                                                                                                     
G8560001003Patient has a history of active drainage from the ear within the previous 90    Pt hx act drain prev 90 days00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8560002004days                                                                                                                                                                                                                                                                                                                 
G8561001003Patient is not eligible for the referral for otologic evaluation for patients   Pt inelig for ref oto eval  00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8561002004with a history of active drainage measure                                                                                                                                                                                                                                                                            
G8562001003Patient does not have a history of active drainage from the ear within the      Pt no hx act drain 90 d     00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8562002004previous 90 days                                                                                                                                                                                                                                                                                                     
G8563001003Patient not referred to a physician (preferably a physician with training in    Pt no ref oto reas no spec  00      9                                                                                                     C                          M5D 1      02010010120130101        N                           
G8563002004disorders of the ear) for an otologic evaluation, reason not given                                                                                                                                                                                                                                                   
G8564001003Patient was referred to a physician (preferably a physician with training in    Pt ref oto eval             00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8564002004disorders of the ear) for an otologic evaluation, reason not specified)                                                                                                                                                                                                                                              
G8565001003Verification and documentation of sudden or rapidly progressive hearing loss    Ver doc hear loss           00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8566001003Patient is not eligible for the "referral for otologic evaluation for sudden or Pt inelig ref oto eval      00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8566002004rapidly progressive hearing loss" measure                                                                                                                                                                                                                                                                            
G8567001003Patient does not have verification and documentation of sudden or rapidly       Pt no doc hear loss         00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8567002004progressive hearing loss                                                                                                                                                                                                                                                                                             
G8568001003Patient was not referred to a physician (preferably a physician with training   Pt no ref otolo no spec     00      9                                                                                                     C                          M5D 1      02010010120130101        N                           
G8568002004in disorders of the ear) for an otologic evaluation, reason not given                                                                                                                                                                                                                                                
G8569001003Prolonged postoperative intubation (> 24 hrs) required                          Prol intubation req         00      9                                                                                                     C                          M5D 1      02010010120140101        N                           
G8570001003Prolonged postoperative intubation (> 24 hrs) not required                      No prol intub req           00      9                                                                                                     C                          M5D 1      02010010120140101        N                           
G8571001003Development of deep sternal wound infection/mediastinitis within 30 days        Ster wd ifx 30 d postop     00      9                                                                                                     C                          M5D 1      02010010120150101        N                           
G8571002004postoperatively                                                                                                                                                                                                                                                                                                      
G8572001003No deep sternal wound infection/mediastinitis                                   No ster wd ifx              00      9                                                                                                     C                          M5D 1      02010010120150101        N                           
G8573001003Stroke following isolated cabg surgery                                          Stk cabg                    00      9                                                                                                     C                          M5D 1      02010010120120101        N                           
G8574001003No stroke following isolated cabg surgery                                       No strk cabg                00      9                                                                                                     C                          M5D 1      02010010120120101        N                           
G8575001003Developed postoperative renal failure or required dialysis                      Postop ren fail             00      9                                                                                                     C                          M5D 1      02010010120120101        N                           
G8576001003No postoperative renal failure/dialysis not required                            No postop ren fail          00      9                                                                                                     C                          M5D 1      02010010120120101        N                           
G8577001003Re-exploration required due to mediastinal bleeding with or without tamponade,  Reop req bld grft oth       00      9                                                                                                     C                          M5D 1      02010010120130101        N                           
G8577002004graft occlusion, valve dysfunction or other cardiac reason                                                                                                                                                                                                                                                           
G8578001003Re-exploration not required due to mediastinal bleeding with or without         No reop req bld grft oth    00      9                                                                                                     C                          M5D 1      02010010120130101        N                           
G8578002004tamponade, graft occlusion, valve dysfunction or other cardiac reason                                                                                                                                                                                                                                                
G8579001003Antiplatelet medication at discharge                                            Antplt med disch            00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8580001003Antiplatelet medication contraindicated                                         Antplt med contraind        00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8581001003No antiplatelet medication at discharge                                         No antplt med disch         00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8582001003Beta-blocker at discharge                                                       Bblock disch                00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8583001003Beta-blocker contraindicated                                                    Bblock contraind            00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8584001003No beta-blocker at discharge                                                    No bblock disch             00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8585001003Anti-lipid treatment at discharge                                               Antilipid treat disch       00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8586001003Anti-lipid treatment contraindicated                                            Antlip disch contra         00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8587001003No anti-lipid treatment at discharge                                            No antlipid treat disch     00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8593001003Lipid profile results documented and reviewed (must include total cholesterol,  Lipid pn results            00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8593002004hdl-c, triglycerides and calculated ldl-c)                                                                                                                                                                                                                                                                           
G8594001003Lipid profile not performed, reason not given                                   No lipid prof perf          00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8595001003Most recent ldl-c < 100 mg/dl                                                   Ldl < 100                   00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8597001003Most recent ldl-c >= 100 mg/dl                                                  Ldl >= 100                  00      9                                                                                                     C                          M5D 1      0201001012015010120141231N                           
G8598001003Aspirin or another antiplatelet therapy used                                    Asa/antiplat ther used      00      9                                                                                                     C                          M5D 1      02010010120170101        N                           
G8599001003Aspirin or another antiplatelet therapy not used, reason not given              No asa/antiplat ther use rng00      9                                                                                                     C                          M5D 1      02010010120170101        N                           
G8600001003Iv t-pa initiated within three hours (<= 180 minutes) of time last known well   Tpa initi w/in 3 hrs        00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8601001003Iv t-pa not initiated within three hours (<= 180 minutes) of time last known    No elig tpa init w/in 3 hrs 00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8601002004well for reasons documented by clinician                                                                                                                                                                                                                                                                             
G8602001003Iv t-pa not initiated within three hours (<= 180 minutes) of time last known    No tpa init w/in 3 hrs      00      9                                                                                                     C                          M5D 1      02010010120130101        N                           
G8602002004well, reason not given                                                                                                                                                                                                                                                                                               
G8627001003Surgical procedure performed within 30 days following cataract surgery for      Surg proc w/in 30 days      00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8627002004major complications (e.g., retained nuclear fragments, endophthalmitis,                                                                                                                                                                                                                                              
G8627003004dislocated or wrong power iol, retinal detachment, or wound dehiscence)                                                                                                                                                                                                                                              
G8628001003Surgical procedure not performed within 30 days following cataract surgery for  No surg proc w/in 30 days   00      9                                                                                                     C                          M5D 1      02010010120100101        N                           
G8628002004major complications (e.g., retained nuclear fragments, endophthalmitis,                                                                                                                                                                                                                                              
G8628003004dislocated or wrong power iol, retinal detachment, or wound dehiscence)                                                                                                                                                                                                                                              
G8629001003Documentation of order for prophylactic parenteral antibiotic to be given       Doc antibio order b/4 surg  00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G8629002004within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical                                                                                                                                                                                                                                      
G8629003004incision (or start of procedure when no incision is required)                                                                                                                                                                                                                                                        
G8630001003Documentation that administration of prophylactic parenteral antibiotics was    Doc antibio given b/4 surg  00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G8630002004initiated within one hour (if fluoroquinolone or vancomycin, two hours) prior                                                                                                                                                                                                                                        
G8630003004to surgical incision (or start of procedure when no incision is required), as                                                                                                                                                                                                                                        
G8630004004ordered                                                                                                                                                                                                                                                                                                              
G8631001003Clinician documented that patient was not an eligible candidate for ordering    Pt no elg 4 order antbi give00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G8631002004prophylactic parenteral antibiotics to be given within one hour (if                                                                                                                                                                                                                                                  
G8631003004fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start                                                                                                                                                                                                                                       
G8631004004of procedure when no incision is required)                                                                                                                                                                                                                                                                           
G8632001003Prophylactic parenteral antibiotics were not ordered to be given or given       Doc no antibi order b/4 surg00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G8632002004within one hour (if fluoroquinolone or vancomycin, two hours) prior to the                                                                                                                                                                                                                                           
G8632003004surgical incision (or start of procedure when no incision is required), reason                                                                                                                                                                                                                                       
G8632004004not given                                                                                                                                                                                                                                                                                                            
G8633001003Pharmacologic therapy (other than minierals/vitamins) for osteoporosis          Pharm ther osteo rx         00      9                                                                                                     C                          M5B 1      02011010120110101        N                           
G8633002004prescribed                                                                                                                                                                                                                                                                                                           
G8634001003Clinician documented patient not an eligible candidate to receive pharmacologic Pt no elg phar ther osteo   00      9                                                                                                     C                          M5B 1      0201101012017010120161231N                           
G8634002004therapy for osteoporosis                                                                                                                                                                                                                                                                                             
G8635001003Pharmacologic therapy for osteoporosis was not prescribed, reason not given     No pharm ther osteo rx      00      9                                                                                                     C                          M5B 1      02011010120130101        N                           
G8645001003I intend to report the asthma measures group                                    Asthma measures grp         00      9                                                                                                     C                          M5B 1      0201101012017010120161231N                           
G8646001003All quality actions for the applicable measures in the asthma measures group    Asthma mg qual act perform  00      9                                                                                                     C                          M5B 1      0201101012017010120161231N                           
G8646002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G8647001003Risk-adjusted functional status change residual score for the knee impairment   Rafscrs ki scor >= 0        00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8647002004successfully calculated and the score was equal to zero (0) or greater than                                                                                                                                                                                                                                          
G8647003004zero (> 0)                                                                                                                                                                                                                                                                                                           
G8648001003Risk-adjusted functional status change residual score for the knee impairment   Rafscrs ki scor < 0         00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8648002004successfully calculated and the score was less than zero (< 0)                                                                                                                                                                                                                                                       
G8649001003Risk-adjusted functional status change residual score for the knee impairment   Rafscrs ki no scor          00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8649002004not measured because the patient did not complete the fs status survey near                                                                                                                                                                                                                                          
G8649003004discharge, patient not appropriate                                                                                                                                                                                                                                                                                   
G8650001003Risk-adjusted functional status change residual scores for the knee impairment  Rafscrs ki no scor no surv  00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8650002004not measured because the patient did not complete the fs intake survey on                                                                                                                                                                                                                                            
G8650003004admission and/or follow up fs status survey near discharge, reason not given                                                                                                                                                                                                                                         
G8651001003Risk-adjusted functional status change residual score for the hip impairment    Rafscrs hi scor >=0         00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8651002004successfully calculated and the score was equal to zero (0) or greater than                                                                                                                                                                                                                                          
G8651003004zero (> 0)                                                                                                                                                                                                                                                                                                           
G8652001003Risk-adjusted functional status change residual score for the hip impairment    Rafscrs hi scor < 0         00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8652002004successfully calculated and the score was less than zero (< 0)                                                                                                                                                                                                                                                       
G8653001003Risk-adjusted functional status change residual scores for the hip impairment   Rafscrs hi no scor          00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8653002004not measured because the patient did not complete the fs status survey near                                                                                                                                                                                                                                          
G8653003004discharge, patient not appropriate                                                                                                                                                                                                                                                                                   
G8654001003Risk-adjusted functional status change residual score for the hip impairment    Rafscrs hi no scor no surv  00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8654002004not measured because the patient did not complete the fs intake survey on                                                                                                                                                                                                                                            
G8654003004admission and/or follow up fs status survey near discharge, reason not given                                                                                                                                                                                                                                         
G8655001003Risk-adjusted functional status change residual score for the lower leg, foot   Rafscrs llfai scor >= 0     00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8655002004or ankle impairment successfully calculated and the score was equal to zero (0)                                                                                                                                                                                                                                      
G8655003004or greater than zero ( > 0)                                                                                                                                                                                                                                                                                          
G8656001003Risk-adjusted functional status change residual score for the lower leg, foot   Rafscrs llfai scor < 0      00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8656002004or ankle impairment successfully calculated and the score was less than zero (<                                                                                                                                                                                                                                      
G86560030040)                                                                                                                                                                                                                                                                                                                   
G8657001003Risk-adjusted functional status change residual score for the lower leg, foot   Rafscrs llfai no scor       00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8657002004or ankle impairment not measured because the patient did not complete the fs                                                                                                                                                                                                                                         
G8657003004status survey near discharge, patient not appropriate                                                                                                                                                                                                                                                                
G8658001003Risk-adjusted functional status change residual score for the lower leg, foot   Rafscrs llfai no scor + surv00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8658002004or ankle impairment not measured because the patient did not complete the fs                                                                                                                                                                                                                                         
G8658003004intake survey on admission and/or follow up fs status survey near discharge,                                                                                                                                                                                                                                         
G8658004004reason not given                                                                                                                                                                                                                                                                                                     
G8659001003Risk-adjusted functional status change residual score for the low back          Rafscrs lbi scor >= 0       00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8659002004impairment successfully calculated and the score was equal to zero (0) or                                                                                                                                                                                                                                            
G8659003004greater than zero (> 0)                                                                                                                                                                                                                                                                                              
G8660001003Risk-adjusted functional status change residual score for the low back          Rafscrs lbi scor < 0        00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8660002004impairment successfully calculated and the score was less than zero (< 0)                                                                                                                                                                                                                                            
G8661001003Risk-adjusted functional status change residual score for the low back          Rafscrs lbi no scor         00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8661002004impairment not measured because the patient did not complete the fs status                                                                                                                                                                                                                                           
G8661003004survey near discharge, patient not appropriate                                                                                                                                                                                                                                                                       
G8662001003Risk-adjusted functional status change residual score for the low back          Rafscrs lbi no scor no surv 00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8662002004impairment not measured because the patient did not complete the fs intake                                                                                                                                                                                                                                           
G8662003004survey on admission and/or follow up fs status survey near discharge, reason                                                                                                                                                                                                                                         
G8662004004not given                                                                                                                                                                                                                                                                                                            
G8663001003Risk-adjusted functional status change residual score for the shoulder          Rafscrs si scor >= 0        00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8663002004impairment successfully calculated and the score was equal to zero (0) or                                                                                                                                                                                                                                            
G8663003004greater than zero (> 0)                                                                                                                                                                                                                                                                                              
G8664001003Risk-adjusted functional status change residual score for the shoulder          Rafscrs si scor < 0         00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8664002004impairment successfully calculated and the score was less than zero (< 0)                                                                                                                                                                                                                                            
G8665001003Risk-adjusted functional status change residual score for the shoulder          Rafscrs si no scor          00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8665002004impairment not measured because the patient did not complete the fs status                                                                                                                                                                                                                                           
G8665003004survey near discharge, patient not appropriate                                                                                                                                                                                                                                                                       
G8666001003Risk-adjusted functional status change residual score for the shoulder          Rafscrs si no scor no surv  00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8666002004impairment not measured because the patient did not complete the fs intake                                                                                                                                                                                                                                           
G8666003004survey on admission and/or follow up fs status survey near discharge, reason                                                                                                                                                                                                                                         
G8666004004not given                                                                                                                                                                                                                                                                                                            
G8667001003Risk-adjusted functional status change residual score for the elbow, wrist or   Rafscrs ewh scor >= 0       00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8667002004hand impairment  successfully calculated and the score was equal to zero (0) or                                                                                                                                                                                                                                      
G8667003004greater than zero (> 0)                                                                                                                                                                                                                                                                                              
G8668001003Risk-adjusted functional status change residual score for the elbow, wrist or   Rafscrs ewh scor < 0        00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8668002004hand impairment  successfully calculated and the score was less than zero (< 0)                                                                                                                                                                                                                                      
G8669001003Risk-adjusted functional status change residual score for the elbow, wrist or   Rafscrs                     00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8669002004hand impairment not measured because the patient did not complete the fs status                                                                                                                                                                                                                                      
G8669003004survey near discharge, patient not appropriate                                                                                                                                                                                                                                                                       
G8670001003Risk-adjusted functional status change residual score for the elbow, wrist or   Rafscrs ewh no scor no surv 00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8670002004hand impairment not measured because the patient did not complete the fs intake                                                                                                                                                                                                                                      
G8670003004survey on admission and/or follow up fs status survey near discharge, reason                                                                                                                                                                                                                                         
G8670004004not given                                                                                                                                                                                                                                                                                                            
G8671001003Risk-adjusted functional status change residual score for the neck, cranium,    Rafscrs goi scor >= 0       00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8671002004mandible, thoracic spine, ribs or other general orthopedic impairment                                                                                                                                                                                                                                                
G8671003004successfully calculated and the score was equal to zero (0) or greater than                                                                                                                                                                                                                                          
G8671004004zero (> 0)                                                                                                                                                                                                                                                                                                           
G8672001003Risk-adjusted functional status change residual score for the neck, cranium,    Rafscrs goi scor < 0        00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8672002004mandible, thoracic spine, ribs or other general orthopedic impairment                                                                                                                                                                                                                                                
G8672003004successfully calculated and the score was less than zero (< 0)                                                                                                                                                                                                                                                       
G8673001003Risk-adjusted functional status change residual score for the neck, cranium,    Rafscrs goi no scor         00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8673002004mandible, thoracic spine, ribs or other general orthopedic impairment not                                                                                                                                                                                                                                            
G8673003004measured because the patient did not complete the fs status survey near                                                                                                                                                                                                                                              
G8673004004discharge, patient not appropriate                                                                                                                                                                                                                                                                                   
G8674001003Risk-adjusted functional status change residual score for the neck, cranium,    Rafscrs neck, no msr/no foto00      9                                                                                                     C                          M5B 1      02011010120190101        C                           
G8674002004mandible, thoracic spine, ribs or other general orthopedic impairment not                                                                                                                                                                                                                                            
G8674003004measured because the patient did not complete the fs status survey on admission                                                                                                                                                                                                                                      
G8674004004and/or follow up fs status survey near discharge, reason not given                                                                                                                                                                                                                                                   
G8682001003Lvf testing documented as being performed prior to discharge or in the previous Lvg test perf               00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G868200200412 months                                                                                                                                                                                                                                                                                                            
G8683001003Lvf testing not performed prior to discharge or in the previous 12 months for a Pt not elig for lvf test    00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G8683002004medical or patient documented reason                                                                                                                                                                                                                                                                                 
G8685001003Lvf testing not documented as being performed prior to discharge or in the      Lvf test not perf           00      9                                                                                                     C                          M5B 1      0201101012015010120141231N                           
G8685002004previous 12 months, reason not given                                                                                                                                                                                                                                                                                 
G8694001003Left ventricular ejection fraction (lvef) < 40%                                 Lvef <40%                   00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8696001003Antithrombotic therapy prescribed at discharge                                  Antithromb thx presc        00      9                                                                                                     C                          M5B 1      0201201012018010120171231N                           
G8697001003Antithrombotic therapy not prescribed for documented reasons (e.g., patient had Antithromb no presc doc reas00      9                                                                                                     C                          M5B 1      0201201012018010120171231N                           
G8697002004stroke during hospital stay, patient expired during inpatient stay, other                                                                                                                                                                                                                                            
G8697003004medical reason(s)); (e.g., patient left against medical advice, other patient                                                                                                                                                                                                                                        
G8697004004reason(s))                                                                                                                                                                                                                                                                                                           
G8698001003Antithrombotic therapy was not prescribed at discharge, reason not given        Antithromb no presc no reas 00      9                                                                                                     C                          M5B 1      0201201012018010120171231N                           
G8699001003Rehabilitation services (occupational, physical or speech) ordered at or prior  Rehab ordered disch         00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8699002004to discharge                                                                                                                                                                                                                                                                                                         
G8700001003Rehabilitation services (occupational, physical or speech) not indicated at or  Rehab not indicated disch   00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8700002004prior to discharge                                                                                                                                                                                                                                                                                                   
G8701001003Rehabilitation services were not ordered, reason not otherwise specified        Rehab not ordered           00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8702001003Documentation that prophylactic antibiotics were given within 4 hours prior to  Antiobiotics 4 hr prior surg00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8702002004surgical incision or intraoperatively                                                                                                                                                                                                                                                                                
G8703001003Documentation that prophylactic antibiotics were neither given within 4 hours   Antibiotics not prior surg  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8703002004prior to surgical incision nor intraoperatively                                                                                                                                                                                                                                                                      
G870400100312-lead electrocardiogram (ecg) performed                                       Ecg performed               00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8705001003Documentation of medical reason(s) for not performing a 12-lead                 Med reas no ecg             00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8705002004electrocardiogram (ecg)                                                                                                                                                                                                                                                                                              
G8706001003Documentation of patient reason(s) for not performing a 12-lead                 Pt reas no ecg              00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8706002004electrocardiogram (ecg)                                                                                                                                                                                                                                                                                              
G870700100312-lead electrocardiogram (ecg) not performed, reason not given                 Ecg not performed           00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8708001003Patient not prescribed or dispensed antibiotic                                  Antibiotic not pres         00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8709001003Patient prescribed or dispensed antibiotic for documented medical reason(s)     Pt presc doc med rsn id uri 00      9                                                                                                     C                          M5B 1      02012010120190101        C                           
G8709002004within three days after the initial diagnosis of uri (e.g., intestinal                                                                                                                                                                                                                                               
G8709003004infection, pertussis, bacterial infection, lyme disease, otitis media, acute                                                                                                                                                                                                                                         
G8709004004sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection                                                                                                                                                                                                                                        
G8709005004of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis,                                                                                                                                                                                                                                        
G8709006004or bone infections, acute lymphadenitis, impetigo, skin staph infections,                                                                                                                                                                                                                                            
G8709007004pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia,                                                                                                                                                                                                                                              
G8709008004inflammatory diseases (female reproductive organs)), infections of the kidney,                                                                                                                                                                                                                                       
G8709009004cystitis or uti, and acne)                                                                                                                                                                                                                                                                                           
G8710001003Patient prescribed or dispensed antibiotic                                      Pt pres antibiotic          00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8711001003Prescribed or dispensed antibiotic                                              Pres antibiotic             00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8712001003Antibiotic not prescribed or dispensed                                          Not pres antibiotic         00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8713001003Spkt/v greater than or equal to 1.2 (single-pool clearance of urea [kt] /       Spkt/v great 1.2 kt/v       00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8713002004volume [v])                                                                                                                                                                                                                                                                                                          
G8714001003Hemodialysis treatment performed exactly three times per week for > 90 days     Hemodialysis 3 times week   00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8717001003Spkt/v less than 1.2 (single-pool clearance of urea [kt] / volume [v]), reason  Less 1.2 kt/v               00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8717002004not given                                                                                                                                                                                                                                                                                                            
G8718001003Total kt/v greater than or equal to 1.7 per week (total clearance of urea [kt]  Great 1.7 kt/v per week     00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8718002004/ volume [v])                                                                                                                                                                                                                                                                                                        
G8720001003Total kt/v less than 1.7 per week (total clearance of urea [kt] / volume [v])   Less 1.7 kt/v per week      00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8721001003Pt category (primary tumor), pn category (regional lymph nodes), and histologic Pt, pn, hist grade doc      00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8721002004grade were documented in pathology report                                                                                                                                                                                                                                                                            
G8722001003Documentation of medical reason(s) for not including the pt category, the pn    Med reas pt, pn, not doc    00      9                                                                                                     C                          M5B 1      02012010120140101        N                           
G8722002004category or the histologic grade in the pathology report (e.g., re-excision                                                                                                                                                                                                                                          
G8722003004without residual tumor; non-carcinomasanal canal)                                                                                                                                                                                                                                                                    
G8723001003Specimen site is other than anatomic location of primary tumor                  Spec sit not prim tumor     00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8724001003Pt category, pn category and histologic grade were not documented in the        Pt, pn, hist grade not doc  00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8724002004pathology report, reason not given                                                                                                                                                                                                                                                                                   
G8725001003Fasting lipid profile performed (triglycerides, ldl-c, hdl-c and total          Lipid profile perf doc      00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8725002004cholesterol)                                                                                                                                                                                                                                                                                                         
G8726001003Clinician has documented reason for not performing fasting lipid profile (e.g., Doc reas no lipid profile   00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8726002004patient declined, other patient reasons)                                                                                                                                                                                                                                                                             
G8728001003Fasting lipid profile not performed, reason not given                           Lipid profile not perf      00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8730001003Pain assessment documented as positive using a standardized tool and a          Pain doc pos and plan       00      9                                                                                                     C                          M5B 1      02012010120140101        N                           
G8730002004follow-up plan is documented                                                                                                                                                                                                                                                                                         
G8731001003Pain assessment using a standardized tool is documented as negative, no         Pain neg no plan            00      9                                                                                                     C                          M5B 1      02012010120140101        N                           
G8731002004follow-up plan required                                                                                                                                                                                                                                                                                              
G8732001003No documentation of pain assessment, reason not given                           No doc of pain              00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8733001003Elder maltreatment screen documented as positive and a follow-up plan is        Doc pos elder mal scrn plan 00      9                                                                                                     C                          M5B 1      02012010120140101        N                           
G8733002004documented                                                                                                                                                                                                                                                                                                           
G8734001003Elder maltreatment screen documented as negative, no follow-up required         Doc neg elder mal no plan   00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8735001003Elder maltreatment screen documented as positive, follow-up plan not            Eld mal scrn pos no plan    00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8735002004documented, reason not given                                                                                                                                                                                                                                                                                         
G8736001003Most current ldl-c <100mg/dl                                                    Ldl-c <100mg/dl             00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8737001003Most current ldl-c >=100mg/dl                                                   Ldl-c >=100mg/dl            00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8738001003Left ventricular ejection fraction (lvef) < 40% or documentation of severely or Lvef < 40%                  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8738002004moderately depressed left ventricular systolic function                                                                                                                                                                                                                                                              
G8739001003Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or  Lvef >= 40%                 00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8739002004mildly depressed left ventricular systolic function                                                                                                                                                                                                                                                                  
G8740001003Left ventricular ejection fraction (lvef) not performed or assessed, reason not Lvef not perfrmd            00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8740002004given                                                                                                                                                                                                                                                                                                                
G8749001003Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs  No signs melanoma           00      9                                                                                                     C                          M5B 1      02012010120190101        C                           
G8749002004such as weakness, or any other sign suggesting systemic spread) or absence of                                                                                                                                                                                                                                        
G8749003004symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom                                                                                                                                                                                                                                        
G8749004004suggesting the possibility of systemic spread of melanoma)                                                                                                                                                                                                                                                           
G8751001003Smoking status and exposure to second hand smoke in the home not assessed,      Smkg status not assess      00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8751002004reason not given                                                                                                                                                                                                                                                                                                     
G8752001003Most recent systolic blood pressure < 140 mmhg                                  Sys bp less 140             00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8753001003Most recent systolic blood pressure >= 140 mmhg                                 Sys bp > or = 140           00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8754001003Most recent diastolic blood pressure < 90 mmhg                                  Dias bp less 90             00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8755001003Most recent diastolic blood pressure >= 90 mmhg                                 Dias bp > or = 90           00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8756001003No documentation of blood pressure measurement, reason not given                No bp measure doc           00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8757001003All quality actions for the applicable measures in the chronic obstructive      Copd mg qual act perform    00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8757002004pulmonary disease (copd) measures group have been performed for this patient                                                                                                                                                                                                                                         
G8758001003All quality actions for the applicable measures in the inflammatory bowel       Ibd mg qual act perform     00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8758002004disease (ibd) measures group have been performed for this patient                                                                                                                                                                                                                                                    
G8759001003All quality actions for the applicable measures in the sleep apnea measures     Osa mg qual act perform     00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8759002004group have been performed for this patient                                                                                                                                                                                                                                                                           
G8761001003All quality actions for the applicable measures in the dementia measures group  Dementia mg qual act perform00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8761002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G8762001003All quality actions for the applicable measures in the parkinson's disease      Pd mg qual act perform      00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8762002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G8763001003All quality actions for the applicable measures in the hypertension (htn)       Hyperten mg qual act perform00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8763002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G8764001003All quality actions for the applicable measures in the cardiovascular           Car prev mg qual act perform00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8764002004prevention measures group have bee performed for this patient                                                                                                                                                                                                                                                        
G8765001003All quality actions for the applicable measures in the cataract measures group  Cataract mg qual act perform00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8765002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G8767001003Lipid panel results documented and reviewed (must include total cholesterol,    Lipid panel res doc rev     00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8767002004hdl-c, triglycerides and calculated ldl-c)                                                                                                                                                                                                                                                                           
G8768001003Documentation of medical reason(s) for not performing lipid profile (e.g.,      Doc med reas no lipid profle00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8768002004patients with palliative goals or for whom treatment of hypertension with                                                                                                                                                                                                                                            
G8768003004standard treatment goals is not clinically appropriate)                                                                                                                                                                                                                                                              
G8769001003Lipid profile not performed, reason not given                                   Lipid profile not perform   00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8770001003Urine protein test result documented and reviewed                               Urine protein test doc rev  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8771001003Documentation of diagnosis of chronic kidney disease                            Doc dx ckd                  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8772001003Documentation of medical reason(s) for not performing urine protein test (e.g., Doc med reas no urine protn 00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8772002004patients with palliative goals or for whom treatment of hypertension with                                                                                                                                                                                                                                            
G8772003004standard treatment goals is not cllinically appropriate)                                                                                                                                                                                                                                                             
G8773001003Urine protein test was not performed, reason not given                          No urine protein test       00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8774001003Serum creatinine test result documented and reviewed                            Serum creatinine doc rev    00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8775001003Documentation of medical reason(s) for not performing serum creatinine test     Doc med reas no serum crtn  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8775002004(e.g., patients with palliative goals or for whom treatment of hypertension                                                                                                                                                                                                                                          
G8775003004with standard treatment goals is not clinically appropriate)                                                                                                                                                                                                                                                         
G8776001003Serum creatinine test not performed, reason not given                           No serum creatinine test    00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8777001003Diabetes screening test performed                                               Diabetes screen             00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8778001003Documentation of medical reason(s) for not performing diabetes screening test   Doc med reas no diabete scrn00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8778002004(e.g., patients with a diagnosis of diabetes, or with palliative goals or for                                                                                                                                                                                                                                        
G8778003004whom treatment of hypertension with standard treatment goals is not clinically                                                                                                                                                                                                                                       
G8778004004appropriate)                                                                                                                                                                                                                                                                                                         
G8779001003Diabetes screening test not performed, reason not given                         No diabetes screen          00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8780001003Counseling for diet and physical activity performed                             Counsel diet phys activity  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8781001003Documentation of medical reason(s) for patient not receiving counseling for     Doc med reas no counsel diet00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8781002004diet and physical activity (e.g., patients with palliative goals or for whom                                                                                                                                                                                                                                         
G8781003004treatment of hypertension with standard treatment goals is not clinically                                                                                                                                                                                                                                            
G8781004004appropriate)                                                                                                                                                                                                                                                                                                         
G8782001003Counseling for diet and physical activity not performed, reason not given       No counsel diet phys act    00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8783001003Normal blood pressure reading documented, follow-up not required                Bp scrn perf rec interval   00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8784001003Patient not eligible (e.g., documentation the patient is not eligible due to    Pt no elig for bp assess    00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8784002004active diagnosis of hypertension, patient refuses, urgent or emergent situation)                                                                                                                                                                                                                                     
G8785001003Blood pressure reading not documented, reason not given                         Bp scrn no perf at interval 00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8797001003Specimen site other than anatomic location of esophagus                         Specimen site not esophagus 00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8798001003Specimen site other than anatomic location of prostate                          Specimen site not prostate  00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8806001003Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy        Perf ultrsnd to lct preg doc00      9                                                                                                     C                          M5B 1      02012010120190101        C                           
G8806002004location documented                                                                                                                                                                                                                                                                                                  
G8807001003Trans-abdominal or trans-vaginal ultrasound not performed for reasons           No ta tv ultrasnd           00      9                                                                                                     C                          M5B 1      02012010120190101        S                           
G8807002004documented by clinician (e.g., patient has visited the ed multiple times within                                                                                                                                                                                                                                      
G880700300472 hours, patient has a documented intrauterine pregnancy [iup])                                                                                                                                                                                                                                                     
G8808001003Trans-abdominal or trans-vaginal ultrasound not performed, reason not given     Ultrasound not perf, rng    00      9                                                                                                     C                          M5B 1      02012010120180101        N                           
G8809001003Rh-immunoglobulin (rhogam) ordered                                              Rh-immunoglobulin order     00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8810001003Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician      Doc reas no rh-immuno       00      9                                                                                                     C                          M5B 1      02012010120140101        N                           
G8810002004(e.g., patient had prior documented receipt of rhogam within 12 weeks, patient                                                                                                                                                                                                                                       
G8810003004refusal)                                                                                                                                                                                                                                                                                                             
G8811001003Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given      No rh-immunoglobulin order  00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8815001003Documented reason in the medical records for why the statin therapy was not     Doc reas no statin therapy  00      9                                                                                                     C                          M5B 1      02012010120170101        N                           
G8815002004prescribed (i.e., lower extremity bypass was for a patient with                                                                                                                                                                                                                                                      
G8815003004non-artherosclerotic disease)                                                                                                                                                                                                                                                                                        
G8816001003Statin medication prescribed at discharge                                       Statin med pres at disch    00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8817001003Statin therapy not prescribed at discharge, reason not given                    Doc reas no statin med disch00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8818001003Patient discharge to home no later than post-operative day #7                   Pt disch to home by day#7   00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8825001003Patient not discharged to home by post-operative day #7                         Pt not disch to home day#7  00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8826001003Patient discharge to home no later than post-operative day #2 following evar    Pt disch home day #2 evar   00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8833001003Patient not discharged to home by post-operative day #2 following evar          Pt not disch home day#2 evar00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8834001003Patient discharged to home no later than post-operative day #2 following cea    Pt disch home day #2 cea    00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8838001003Patient not discharged to home by post-operative day #2 following cea           Not disch home by day #2    00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8839001003Sleep apnea symptoms assessed, including presence or absence of snoring and     Sleep apnea assess          00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8839002004daytime sleepiness                                                                                                                                                                                                                                                                                                   
G8840001003Documentation of reason(s) for not documenting an assessment of sleep symptoms  Doc reas no sleep apnea     00      9                                                                                                     C                          M5B 1      02012010120150101        N                           
G8840002004(e.g., patient didn't have initial daytime sleepiness, patient visited between                                                                                                                                                                                                                                       
G8840003004initial testing and initiation of therapy)                                                                                                                                                                                                                                                                           
G8841001003Sleep apnea symptoms not assessed, reason not given                             No sleep apnea assess       00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8842001003Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) measured at   Ahi or rdi initial dx       00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8842002004the time of initial diagnosis                                                                                                                                                                                                                                                                                        
G8843001003Documentation of reason(s) for not measuring an apnea hypopnea index (ahi) or a Doc reas no ahi or rdi      00      9                                                                                                     C                          M5B 1      02012010120150101        N                           
G8843002004respiratory disturbance index (rdi) at the time of initial diagnosis (e.g.,                                                                                                                                                                                                                                          
G8843003004psychiatric disease, dementia, patient declined, financial, insurance coverage,                                                                                                                                                                                                                                      
G8843004004test ordered but not yet completed)                                                                                                                                                                                                                                                                                  
G8844001003Apnea hypopnea index (ahi) or respiratory disturbance index (rdi) not measured  No ahi or rdi initial dx    00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8844002004at the time of initial diagnosis, reason not given                                                                                                                                                                                                                                                                   
G8845001003Positive airway pressure therapy prescribed                                     Pos airway press prescribed 00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8846001003Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or       Mod or severe osa           00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8846002004respiratory disturbance index (rdi) of 15 or greater)                                                                                                                                                                                                                                                                
G8848001003Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory         Mild osa                    00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8848002004disturbance index (rdi) of less than 15)                                                                                                                                                                                                                                                                             
G8849001003Documentation of reason(s) for not prescribing positive airway pressure therapy Doc reas no pos air press   00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8849002004(e.g., patient unable to tolerate, alternative therapies use, patient declined,                                                                                                                                                                                                                                      
G8849003004financial, insurance coverage)                                                                                                                                                                                                                                                                                       
G8850001003Positive airway pressure therapy not prescribed, reason not given               No pap prescribed           00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8851001003Objective measurement of adherence to positive airway pressure therapy,         Adhere pos air press therapy00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8851002004documented                                                                                                                                                                                                                                                                                                           
G8852001003Positive airway pressure therapy prescribed                                     Pos air press prescribe     00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8853001003Positive airway pressure therapy not prescribed                                 Pos air press not prescribe 00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8854001003Documentation of reason(s) for not objectively measuring adherence to positive  Reas no adhere pos air pres 00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8854002004airway pressure therapy (e.g., patient didn't bring data from continous                                                                                                                                                                                                                                              
G8854003004positive airway pressure [cpap], therapy not yet initiated, not available on                                                                                                                                                                                                                                         
G8854004004machine)                                                                                                                                                                                                                                                                                                             
G8855001003Objective measurement of adherence to positive airway pressure therapy not      Pos air press adhere no perf00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8855002004performed, reason not given                                                                                                                                                                                                                                                                                          
G8856001003Referral to a physician for an otologic evaluation performed                    Ref for oto eval            00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8857001003Patient is not eligible for the referral for otologic evaluation measure (e.g., No elig ref for oto eval    00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8857002004patients who are already under the care of a physician for acute or chronic                                                                                                                                                                                                                                          
G8857003004dizziness)                                                                                                                                                                                                                                                                                                           
G8858001003Referral to a physician for an otologic evaluation not performed, reason not    Not ref for oto eval        00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8858002004given                                                                                                                                                                                                                                                                                                                
G8859001003Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or   Corticosteroids 10mg 60 days00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8859002004greater consecutive days                                                                                                                                                                                                                                                                                             
G8860001003Patients who have received dose of corticosteroids greater than or equal to     Corticosteroid 10 mg 60 days00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G886000200410mg/day for 60 or greater consecutive days                                                                                                                                                                                                                                                                          
G8861001003Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered Dxa ordered for osteo       00      9                                                                                                     C                          M5B 1      02012010120150101        N                           
G8861002004and documented, review of systems and medication history or pharmacologic                                                                                                                                                                                                                                            
G8861003004therapy (other than minerals/vitamins) for osteoporosis prescribed                                                                                                                                                                                                                                                   
G8862001003Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 No corticostrd 10mg 60 days 00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8862002004or greater consecutive days                                                                                                                                                                                                                                                                                          
G8863001003Patients not assessed for risk of bone loss, reason not given                   No assess bone loss         00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8864001003Pneumococcal vaccine administered or previously received                        Pneumococcal vaccine admin  00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8865001003Documentation of medical reason(s) for not administering or previously          Doc med reas no pneumococcal00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8865002004receiving pneumococcal vaccine (e.g., patient allergic reaction, potential                                                                                                                                                                                                                                           
G8865003004adverse drug reaction)                                                                                                                                                                                                                                                                                               
G8866001003Documentation of patient reason(s) for not administering or previously          Doc pt reas no pneumococcal 00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8866002004receiving pneumococcal vaccine (e.g., patient refusal)                                                                                                                                                                                                                                                               
G8867001003Pneumococcal vaccine not administered or previously received, reason not given  No pneumococcal admin       00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8868001003Patients receiving a first course of anti-tnf therapy                           1st course antitnf          00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8869001003Patient has documented immunity to hepatitis b and initiating anti-tnf therapy  Doc immune hep b antitnf    00      9                                                                                                     C                          M5B 1      02012010120180101        N                           
G8870001003Hepatitis b vaccine injection administered or previously received and is        Hepb admin 1st antitnf      00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8870002004receiving a first course of anti-tnf therapy                                                                                                                                                                                                                                                                         
G8871001003Patient not receiving a first course of anti-tnf therapy                        No 1st antitnf              00      9                                                                                                     C                          M5B 1      0201201012016010120151231N                           
G8872001003Excised tissue evaluated by imaging intraoperatively to confirm successful      Intraop image confirm excise00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8872002004inclusion of targeted lesion                                                                                                                                                                                                                                                                                         
G8873001003Patients with needle localization specimens which are not amenable to           Specimen not intraop image  00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8873002004intraoperative imaging such as mri needle wire localization, or targets which                                                                                                                                                                                                                                        
G8873003004are tentatively identified on mammogram or ultrasound which do not contain a                                                                                                                                                                                                                                         
G8873004004biopsy marker but which can be verified on intraoperative inspection or                                                                                                                                                                                                                                              
G8873005004pathology (e.g., needle biopsy site where the biopsy marker is remote from the                                                                                                                                                                                                                                       
G8873006004actual biopsy site)                                                                                                                                                                                                                                                                                                  
G8874001003Excised tissue not evaluated by imaging intraoperatively to confirm successful  Tissue not image intraop    00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8874002004inclusion of targeted lesion                                                                                                                                                                                                                                                                                         
G8875001003Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy Breast cancer dx min invsive00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8875002004method                                                                                                                                                                                                                                                                                                               
G8876001003Documentation of reason(s) for not performing minimally invasive biopsy to      Doc reas no min inv dx      00      9                                                                                                     C                          M5B 1      02012010120150101        N                           
G8876002004diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant,                                                                                                                                                                                                                                      
G8876003004chest wall, etc., lesion could not be adequately visualized for needle biopsy,                                                                                                                                                                                                                                       
G8876004004patient condition prevents needle biopsy [weight, breast thickness, etc.], duct                                                                                                                                                                                                                                      
G8876005004excision without imaging abnormality, prophylactic mastectomy, reduction                                                                                                                                                                                                                                             
G8876006004mammoplasty, excisional biopsy performed by another physician)                                                                                                                                                                                                                                                       
G8877001003Clinician did not attempt to achieve the diagnosis of breast cancer             No brst cncr dx min invasive00      9                                                                                                     C                          M5B 1      02012010120130101        N                           
G8877002004preoperatively by a minimally invasive biopsy method, reason not given                                                                                                                                                                                                                                               
G8878001003Sentinel lymph node biopsy procedure performed                                  Sent lymph node biopsy      00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8879001003Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer              Node neg inv brst cncr      00      9                                                                                                     C                          M5B 1      0201201012018010120171231N                           
G8880001003Documentation of reason(s) sentinel lymph node biopsy not performed (e.g.,      Sen lym p node biop not perf00      9                                                                                                     C                          M5B 1      02012010120190101        C                           
G8880002004reasons could include but not limited to; non-invasive cancer, incidental                                                                                                                                                                                                                                            
G8880003004discovery of breast cancer on prophylactic mastectomy, incidental discovery of                                                                                                                                                                                                                                       
G8880004004breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node                                                                                                                                                                                                                                       
G8880005004(ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer,                                                                                                                                                                                                                                            
G8880006004recurrent invasive breast cancer, clinically node positive after neoadjuvant                                                                                                                                                                                                                                         
G8880007004systemic therapy, patient refusal after informed consent, patient with                                                                                                                                                                                                                                               
G8880008004significant age, comorbidities, or limited life expectancy and favorable tumor;                                                                                                                                                                                                                                      
G8880009004adjuvant systemic therapy unlikely to change)                                                                                                                                                                                                                                                                        
G8881001003Stage of breast cancer is greater than t1n0m0 or t2n0m0                         Brst cncr stage > t1n0m0    00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8882001003Sentinel lymph node biopsy procedure not performed, reason not given            No sent lymph node biopsy   00      9                                                                                                     C                          M5B 1      02012010120140101        N                           
G8883001003Biopsy results reviewed, communicated, tracked and documented                   Rev, comm, track, doc biopsy00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8884001003Clinician documented reason that patient's biopsy results were not reviewed     Doc reas biopsy not review  00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8885001003Biopsy results not reviewed, communicated, tracked or documented                No rev, comm, track biopsy  00      9                                                                                                     C                          M5B 1      02012010120120101        N                           
G8886001003Most recent blood pressure under control                                        Bp under control            00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8887001003Documentation of medical reason(s) for most recent blood pressure not being     Doc med reas bp not control 00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8887002004under control (e.g., patients with palliative goals or for whom treatment of                                                                                                                                                                                                                                         
G8887003004hypertension with standard treatment goals is not clinically appropriate)                                                                                                                                                                                                                                            
G8888001003Most recent blood pressure not under control, results documented and reviewed   Bp not under control        00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8889001003No documentation of blood pressure measurement, reason not given                No doc bp                   00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8890001003Most recent ldl-c under control, results documented and reviewed                Ldl-c under control         00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8891001003Documentation of medical reason(s) for most recent ldl-c not under control      Doc med reas no ldl-c contrl00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8891002004(e.g., patients with palliative goals for whom treatment of hypertension                                                                                                                                                                                                                                         
G8891003004with standard treatment goals is not clinically appropriate)                                                                                                                                                                                                                                                         
G8892001003Documentation of medical reason(s) for not performing ldl-c test (e.g. patients Doc med reas no ldl-c test  00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8892002004with palliative goals or for whom treatment of hypertension with standard                                                                                                                                                                                                                                            
G8892003004treatment goals is not clinically appropriate)                                                                                                                                                                                                                                                                       
G8893001003Most recent ldl-c not under control, results documented and reviewed            Ldl-c not under control     00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8894001003Ldl-c not performed, reason not given                                           Ldl-c not performed         00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8895001003Oral aspirin or other antithrombotic therapy prescribed                         Antrom prescribe            00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8896001003Documentation of medical reason(s) for not prescribing oral aspirin or other    Doc med reas no antihtrom   00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8896002004antithrombotic therapy (e.g., patient documented to be low risk or patient with                                                                                                                                                                                                                                      
G8896003004terminal illness or treatment of hypertension with standard treatment goals is                                                                                                                                                                                                                                       
G8896004004not clinically appropriate, or for whom risk of aspirin or other antithrombotic                                                                                                                                                                                                                                      
G8896005004therapy exceeds potential benefits such as for individuals whose blood pressure                                                                                                                                                                                                                                      
G8896006004is poorly controlled)                                                                                                                                                                                                                                                                                                
G8897001003Oral aspirin or other antithrombotic therapy was not prescribed, reason not     Antithrom not prescribe     00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8897002004given                                                                                                                                                                                                                                                                                                                
G8898001003I intend to report the chronic obstructive pulmonary disease (copd) measures    Copd measures group         00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8898002004group                                                                                                                                                                                                                                                                                                                
G8899001003I intend to report the inflammatory bowel disease (ibd) measures group          Inflammatory bowel dis mg   00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8900001003I intend to report the sleep apnea measures group                               Obstructive sleep apnea mg  00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8902001003I intend to report the dementia measures group                                  Dementia measures group     00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8903001003I intend to report the parkinson's disease measures group                       Parkinson's disease mg      00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8904001003I intend to report the hypertension (htn) measures group                        Hypertension mg             00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8905001003I intend to report the cardiovascular prevention measures group                 Cardiovascular prevention mg00      9                                                                                                     C                          M5B 1      0201201012015010120141231N                           
G8906001003I intend to report the cataract measures group                                  Cataract measures group     00      9                                                                                                     C                          M5B 1      0201201012017010120161231N                           
G8907001003Patient documented not to have experienced any of the following events: a burn  Pt doc no events on discharg00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8907002004prior to discharge; a fall within the facility; wrong                                                                                                                                                                                                                                                                
G8907003004site/side/patient/procedure/implant event; or a hospital transfer or hospital                                                                                                                                                                                                                                        
G8907004004admission upon discharge from the facility                                                                                                                                                                                                                                                                           
G8908001003Patient documented to have received a burn prior to discharge                   Pt doc w burn prior to d/c  00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8909001003Patient documented not to have received a burn prior to discharge               Pt doc no burn prior to d/c 00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8910001003Patient documented to have experienced a fall within asc                        Pt doc to have fall in asc  00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8911001003Patient documented not to have experienced a fall within ambulatory surgical    Pt doc no fall in asc       00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8911002004center                                                                                                                                                                                                                                                                                                               
G8912001003Patient documented to have experienced a wrong site, wrong side, wrong patient, Pt doc with wrong event     00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8912002004wrong procedure or wrong implant event                                                                                                                                                                                                                                                                               
G8913001003Patient documented not to have experienced a wrong site, wrong side, wrong      Pt doc no wrong event       00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8913002004patient, wrong procedure or wrong implant event                                                                                                                                                                                                                                                                      
G8914001003Patient documented to have experienced a hospital transfer or hospital          Pt trans to hosp post d/c   00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8914002004admission upon discharge from asc                                                                                                                                                                                                                                                                                    
G8915001003Patient documented not to have experienced a hospital transfer or hospital      Pt not trans to hosp at d/c 00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8915002004admission upon discharge from asc                                                                                                                                                                                                                                                                                    
G8916001003Patient with preoperative order for iv antibiotic surgical site infection (ssi) Pt w iv ab given on time    00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8916002004prophylaxis, antibiotic initiated on time                                                                                                                                                                                                                                                                            
G8917001003Patient with preoperative order for iv antibiotic surgical site infection (ssi) Pt w iv ab not given on time00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8917002004prophylaxis, antibiotic not initiated on time                                                                                                                                                                                                                                                                        
G8918001003Patient without preoperative order for iv antibiotic surgical site infection    Pt w/o preop order iv ab pro00      9                                                                                                     C                          M5B 1      02012040120120401        N                           
G8918002004(ssi) prophylaxis                                                                                                                                                                                                                                                                                                    
G8923001003Left ventricular ejection fraction (lvef) < 40% or documentation of moderately  Lvef < 40% or lvsd          00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8923002004or severely depressed left ventricular systolic function                                                                                                                                                                                                                                                             
G8924001003Spirometry test results demonstrate fev1/fvc < 70%, fev < 60% predicted and     Spir fev1/fvc<70%,fev<60%   00      9                                                                                                     C                          M5B 1      02013010120170101        N                           
G8924002004patient has copd symptoms (e.g., dyspnea, cough/sputum, wheezing)                                                                                                                                                                                                                                                    
G8925001003Spirometry test results demonstrate fev1 >= 60% fev1/fvc >= 70%, predicted or   Spir fev1/fvc>=60% & no copd00      9                                                                                                     C                          M5B 1      02013010120170101        N                           
G8925002004patient does not have copd symptoms                                                                                                                                                                                                                                                                                  
G8926001003Spirometry test not performed or documented, reason not given                   Spiro no perf or doc        00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8927001003Adjuvant chemotherapy referred, prescribed or previously received for ajcc      Adj chem pres ajcc iii      00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8927002004stage iii, colon cancer                                                                                                                                                                                                                                                                                              
G8928001003Adjuvant chemotherapy not prescribed or previously received, for documented     Adj chem not pres rsn spec  00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8928002004reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior                                                                                                                                                                                                                                        
G8928003004to the current visit date, patient's diagnosis date is within 120 days of the                                                                                                                                                                                                                                        
G8928004004end of the 12 month reporting period, patient's cancer has metastasized,                                                                                                                                                                                                                                             
G8928005004medical contraindication/allergy, poor performance status, other medical                                                                                                                                                                                                                                             
G8928006004reasons, patient refusal, other patient reasons, patient is currently enrolled                                                                                                                                                                                                                                       
G8928007004in a clinical trial that precludes prescription of chemotherapy, other system                                                                                                                                                                                                                                        
G8928008004reasons)                                                                                                                                                                                                                                                                                                             
G8929001003Adjuvant chemotherapy not prescribed or previously received, reason not given   Adj cmo not pres rsn not gvn00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8930001003Assessment of depression severity at the initial evaluation                     Assess of dep @ initial eval00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8931001003Assessment of depression severity not documented, reason not given              Asses of dep not documented 00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8932001003Suicide risk assessed at the initial evaluation                                 Suicd rsk assessed init eval00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8933001003Suicide risk not assessed at the initial evaluation, reason not given           Suicide risk not assessed   00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8934001003Left ventricular ejection fraction (lvef) <40% or documentation of moderately   Lvef <40% or dep lv sys fcn 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8934002004or severely depressed left ventricular systolic function                                                                                                                                                                                                                                                             
G8935001003Clinician prescribed angiotensin converting enzyme (ace) inhibitor or           Rx ace or arb therapy       00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8935002004angiotensin receptor blocker (arb) therapy                                                                                                                                                                                                                                                                           
G8936001003Clinician documented that patient was not an eligible candidate for angiotensin Pt not eligible ace/arb     00      9                                                                                                     C                          M5B 1      02013010120150101        N                           
G8936002004converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy                                                                                                                                                                                                                                      
G8936003004(eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor,                                                                                                                                                                                                                                            
G8936004004diseases of the aortic or mitral valve, other medical reasons) or (eg, patient                                                                                                                                                                                                                                       
G8936005004declined, other patient reasons) or (eg, lack of drug availability, other                                                                                                                                                                                                                                            
G8936006004reasons attributable to the health care system)                                                                                                                                                                                                                                                                      
G8937001003Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or    No rx ace/arb therapy       00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8937002004angiotensin receptor blocker (arb) therapy, reason not given                                                                                                                                                                                                                                                         
G8938001003Bmi is documented as being outside of normal limits, follow-up plan is not      Bmi doc onl fup nt doc      00      9                                                                                                     C                          M5B 1      02013010120180101        N                           
G8938002004documented, documentation the patient is not eligible                                                                                                                                                                                                                                                                
G8939001003Pain assessment documented as positive, follow-up plan not documented,          Pain as doc positive, no f/u00      9                                                                                                     C                          M5B 1      02013010120180101        N                           
G8939002004documentation the patient is not eligible at the time of the encounter                                                                                                                                                                                                                                               
G8940001003Screening for depression documented as positive, a follow-up plan not           Scr dep pos, no plan done   00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8940002004completed, documented reason                                                                                                                                                                                                                                                                                         
G8941001003Elder maltreatment screen documented as positive, follow-up plan not            Eld maltreatment doc as pos 00      9                                                                                                     C                          M5B 1      02013010120180101        N                           
G8941002004documented, documentation the patient is not eligible for follow-up plan at the                                                                                                                                                                                                                                      
G8941003004time of the encounter                                                                                                                                                                                                                                                                                                
G8942001003Functional outcomes assessment using a standardized tool is documented within   Doc fcn/care plan w/30 days 00      9                                                                                                     C                          M5B 1      02013010120140101        N                           
G8942002004the previous 30 days and care plan, based on identified deficiencies on the                                                                                                                                                                                                                                          
G8942003004date of the functional outcome assessment, is documented                                                                                                                                                                                                                                                             
G8943001003Ldl-c result not present or not within 12 months prior                          Ldlc not pres w/i 12 mo prir00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8944001003Ajcc melanoma cancer stage 0 through iic melanoma                               Ajcc mel cnr stg 0 - iic    00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8946001003Minimally invasive biopsy method attempted but not diagnostic of breast cancer  Mibm but no dx of breast ca 00      9                                                                                                     C                          M5B 1      02013010120140101        N                           
G8946002004(e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular                                                                                                                                                                                                                                       
G8946003004neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical                                                                                                                                                                                                                                         
G8946004004columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing                                                                                                                                                                                                                                        
G8946005004lesion, papillary lesion, or any lesion with spindle cells)                                                                                                                                                                                                                                                          
G8947001003One or more neuropsychiatric symptoms                                           1 or more neuropsych        00      9                                                                                                     C                          M5B 1      0201301012018010120171231N                           
G8948001003No neuropsychiatric symptoms                                                    No neuropsych symptoms      00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8949001003Documentation of patient reason(s) for patient not receiving counseling for     Doc pt reas on counsel diet 00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8949002004diet and physical activity (e.g., patient is not willing to discuss diet or                                                                                                                                                                                                                                          
G8949003004exercise interventions to help control blood pressure, or the patient said                                                                                                                                                                                                                                           
G8949004004he/she refused to make these changes)                                                                                                                                                                                                                                                                                
G8950001003Pre-hypertensive or hypertensive blood pressure reading documented, and the     Pre-htn or htn doc, f/u indc00      9                                                                                                     C                          M5B 1      02013010120140101        N                           
G8950002004indicated follow-up is documented                                                                                                                                                                                                                                                                                    
G8951001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated   Pre-htn/htn doc, no pt f/u  00      9                                                                                                     C                          M5B 1      0201301012016010120151231N                           
G8951002004follow-up not documented, documentation the patient is not eligible                                                                                                                                                                                                                                                  
G8952001003Pre-hypertensive or hypertensive blood pressure reading documented, indicated   Pre-htn/htn, no f/u, not gvn00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8952002004follow-up not documented, reason not given                                                                                                                                                                                                                                                                           
G8953001003All quality actions for the applicable measures in the oncology measures group  Oncology mg qual act perform00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8953002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G8955001003Most recent assessment of adequacy of volume management documented              Most recent assess vol mgmt 00      9                                                                                                     C                          M5B 1      02013010120160101        N                           
G8956001003Patient receiving maintenance hemodialysis in an outpatient dialysis facility   Pt rcv hedia outpt dyls fac 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8957001003Patient not receiving maintenance hemodialysis in an outpatient dialysis        Pt no hedia in outpt fac    00      9                                                                                                     C                          M5B 1      0201301012015010120141231N                           
G8957002004facility                                                                                                                                                                                                                                                                                                             
G8958001003Assessment of adequacy of volume management not documented, reason not given    Assess vol mgmt not doc     00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8959001003Clinician treating major depressive disorder communicates to clinician treating Clin tx mdd comm to tx clin 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8959002004comorbid condition                                                                                                                                                                                                                                                                                                   
G8960001003Clinician treating major depressive disorder did not communicate to clinician   Clin tx mdd not comm        00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8960002004treating comorbid condition, reason not given                                                                                                                                                                                                                                                                        
G8961001003Cardiac stress imaging test primarily performed on low-risk surgery patient for Csit lowrisk surg pts preop 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8961002004preoperative evaluation within 30 days preceding this surgery                                                                                                                                                                                                                                                        
G8962001003Cardiac stress imaging test performed on patient for any reason including those Csit on pt any reas 30 days 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8962002004who did not have low risk surgery or test that was performed more than 30 days                                                                                                                                                                                                                                       
G8962003004preceding low risk surgery                                                                                                                                                                                                                                                                                           
G8963001003Cardiac stress imaging performed primarily for monitoring of asymptomatic       Csi per asx pt w/pci 2 yrs  00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8963002004patient who had pci within 2 years                                                                                                                                                                                                                                                                                   
G8964001003Cardiac stress imaging test performed primarily for any other reason than       Csi any other than pci 2 yr 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8964002004monitoring of asymptomatic patient who had pci within 2 years (e.g.,                                                                                                                                                                                                                                                 
G8964003004symptomatic patient, patient greater than 2 years since pci, initial                                                                                                                                                                                                                                                 
G8964004004evaluation, etc)                                                                                                                                                                                                                                                                                                     
G8965001003Cardiac stress imaging test primarily performed on low chd risk patient for     Csit perf on low chd rsk    00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8965002004initial detection and risk assessment                                                                                                                                                                                                                                                                                
G8966001003Cardiac stress imaging test performed on symptomatic or higher than low chd     Csit perf sx or high chd rsk00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8966002004risk patient or for any reason other than initial detection and risk assessment                                                                                                                                                                                                                                      
G8967001003Warfarin or another fda approved oral anticoagulant is prescribed               Warf or other fda drug presc00      9                                                                                                     C                          M5B 1      02013010120180101        N                           
G8968001003Documentation of medical reason(s) for not prescribing warfarin or another      Doc med not presb           00      9                                                                                                     C                          M5B 1      02013010120180101        N                           
G8968002004fda-approved anticoagulant (e.g., atrial appendage device in place)                                                                                                                                                                                                                                                  
G8969001003Documentation of patient reason(s) for not prescribing warfarin or another      Doc pt rsn no presc warf/fda00      9                                                                                                     C                          M5B 1      02013010120180101        N                           
G8969002004fda-approved oral anticoagulant that is fda approved for the prevention of                                                                                                                                                                                                                                           
G8969003004thromboembolism (e.g., patient choice of having atrial appendage device placed)                                                                                                                                                                                                                                      
G8970001003No risk factors or one moderate risk factor for thromboembolism                 No rsk fac or 1 mod risk te 00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8971001003Warfarin or another oral anticoagulant that is fda approved not prescribed,     Warfrn or othr antcog no rx 00      9                                                                                                     C                          M5B 1      0201301012018010120171231N                           
G8971002004reason not given                                                                                                                                                                                                                                                                                                     
G8972001003One or more high risk factors for thromboembolism or more than one moderate     1>=risk or>= mod risk for te00      9                                                                                                     C                          M5B 1      0201301012018010120171231N                           
G8972002004risk factor for thromboembolism                                                                                                                                                                                                                                                                                      
G8973001003Most recent hemoglobin (hgb) level < 10 g/dl                                    Mst rcnt hbb < 10g/dl       00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8974001003Hemoglobin level measurement not documented, reason not given                   Hgb not doc rns not gvn     00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8975001003Documentation of medical reason(s) for patient having a hemoglobin level < 10   Hgb <10g/dl, med rsn        00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8975002004g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell                                                                                                                                                                                                                                      
G8975003004anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease,                                                                                                                                                                                                                                      
G8975004004anemia related to chemotherapy for diagnosis of malignancy, postoperative                                                                                                                                                                                                                                            
G8975005004bleeding, active bloodstream or peritoneal infection], other medical reasons)                                                                                                                                                                                                                                        
G8976001003Most recent hemoglobin (hgb) level >= 10 g/dl                                   Hgb >= 10 g/dl              00      9                                                                                                     C                          M5B 1      02013010120130101        N                           
G8977001003I intend to report the oncology measures group                                  Oncology measures grp       00      9                                                                                                     C                          M5B 1      0201301012017010120161231N                           
G8978001003Mobility: walking & moving around functional limitation, current status, at     Mobility current status     00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8978002004therapy episode outset and at reporting intervals                                                                                                                                                                                                                                                                    
G8979001003Mobility: walking & moving around functional limitation, projected goal status, Mobility goal status        00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8979002004at therapy episode outset, at reporting intervals, and at discharge or to end                                                                                                                                                                                                                                        
G8979003004reporting                                                                                                                                                                                                                                                                                                            
G8980001003Mobility: walking & moving around functional limitation, discharge status, at   Mobility d/c status         00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8980002004discharge from therapy or to end reporting                                                                                                                                                                                                                                                                           
G8981001003Changing & maintaining body position functional limitation, current status, at  Body pos current status     00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8981002004therapy episode outset and at reporting intervals                                                                                                                                                                                                                                                                    
G8982001003Changing & maintaining body position functional limitation, projected goal      Body pos goal status        00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8982002004status, at therapy episode outset, at reporting intervals, and at discharge or                                                                                                                                                                                                                                       
G8982003004to end reporting                                                                                                                                                                                                                                                                                                     
G8983001003Changing & maintaining body position functional limitation, discharge status,   Body pos d/c status         00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8983002004at discharge from therapy or to end reporting                                                                                                                                                                                                                                                                        
G8984001003Carrying, moving & handling objects functional limitation, current status, at   Carry current status        00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8984002004therapy episode outset and at reporting intervals                                                                                                                                                                                                                                                                    
G8985001003Carrying, moving and handling objects, projected goal status, at therapy        Carry goal status           00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8985002004episode outset, at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                         
G8986001003Carrying, moving & handling objects functional limitation, discharge status, at Carry d/c status            00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8986002004discharge from therapy or to end reporting                                                                                                                                                                                                                                                                           
G8987001003Self care functional limitation, current status, at therapy episode outset and  Self care current status    00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8987002004at reporting intervals                                                                                                                                                                                                                                                                                               
G8988001003Self care functional limitation, projected goal status, at therapy episode      Self care goal status       00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8988002004outset, at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                                 
G8989001003Self care functional limitation, discharge status, at discharge from therapy or Self care d/c status        00      9                                                                                                     C                          M5D 1      02013010120130101        N                           
G8989002004to end reporting                                                                                                                                                                                                                                                                                                     
G8990001003Other physical or occupational therapy primary functional limitation, current   Other pt/ot current status  00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8990002004status, at therapy episode outset and at reporting intervals                                                                                                                                                                                                                                                         
G8991001003Other physical or occupational therapy primary functional limitation, projected Other pt/ot goal status     00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8991002004goal status, at therapy episode outset, at reporting intervals, and at                                                                                                                                                                                                                                               
G8991003004discharge or to end reporting                                                                                                                                                                                                                                                                                        
G8992001003Other physical or occupational therapy primary functional limitation, discharge Other pt/ot  d/c status     00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8992002004status, at discharge from therapy or to end reporting                                                                                                                                                                                                                                                                
G8993001003Other physical or occupational therapy subsequent functional limitation,        Sub pt/ot current status    00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8993002004current status, at therapy episode outset and at reporting intervals                                                                                                                                                                                                                                                 
G8994001003Other physical or occupational therapy subsequent functional limitation,        Sub pt/ot goal status       00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8994002004projected goal status, at therapy episode outset, at reporting intervals, and                                                                                                                                                                                                                                        
G8994003004at discharge or to end reporting                                                                                                                                                                                                                                                                                     
G8995001003Other physical or occupational therapy subsequent functional limitation,        Sub pt/ot d/c status        00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8995002004discharge status, at discharge from therapy or to end reporting                                                                                                                                                                                                                                                      
G8996001003Swallowing functional limitation, current status at therapy episode outset and  Swallow current status      00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8996002004at reporting intervals                                                                                                                                                                                                                                                                                               
G8997001003Swallowing functional limitation, projected goal status, at therapy episode     Swallow goal status         00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8997002004outset, at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                                 
G8998001003Swallowing functional limitation, discharge status, at discharge from therapy   Swallow d/c status          00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8998002004or to end reporting                                                                                                                                                                                                                                                                                                  
G8999001003Motor speech functional limitation, current status at therapy episode outset    Motor speech current status 00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G8999002004and at reporting intervals                                                                                                                                                                                                                                                                                           
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)                                                                                                                                                                                                                                                                                               
G9033001003Amantadine hydrochloride, oral brand, per 100 mg (for use in a                  Amantadine hcl oral brand   13      A                                                                                                     C                          O1E 1      02004120120041201        N                           
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)                                                                                                                                                                                                                                                                             
G9050001003Oncology; primary focus of visit; work-up, evaluation, or staging at the time   Oncology work-up evaluation 00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9050002004of cancer diagnosis or recurrence (for use in a medicare-approved demonstration                                                                                                                                                                                                                                      
G9050003004project)                                                                                                                                                                                                                                                                                                             
G9051001003Oncology; primary focus of visit; treatment decision-making after disease is    Oncology tx decision-mgmt   00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9051002004staged or restaged, discussion of treatment options, supervising/coordinating                                                                                                                                                                                                                                        
G9051003004active cancer directed therapy or managing consequences of cancer directed                                                                                                                                                                                                                                           
G9051004004therapy (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                       
G9052001003Oncology; primary focus of visit; surveillance for disease recurrence for       Onc surveillance for disease00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9052002004patient who has completed definitive cancer-directed therapy and currently                                                                                                                                                                                                                                           
G9052003004lacks evidence of recurrent disease; cancer directed therapy might be                                                                                                                                                                                                                                                
G9052004004considered in the future (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                      
G9053001003Oncology; primary focus of visit; expectant management of patient with evidence Onc expectant management pt 00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9053002004of cancer for whom no cancer directed therapy is being administered or arranged                                                                                                                                                                                                                                      
G9053003004at present; cancer directed therapy might be considered in the future (for use                                                                                                                                                                                                                                       
G9053004004in a medicare-approved demonstration project)                                                                                                                                                                                                                                                                        
G9054001003Oncology; primary focus of visit; supervising, coordinating or managing care of Onc supervision palliative  00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9054002004patient with terminal cancer or for whom other medical illness prevents further                                                                                                                                                                                                                                      
G9054003004cancer treatment; includes symptom management, end-of-life care planning,                                                                                                                                                                                                                                            
G9054004004management of palliative therapies (for use in a medicare-approved                                                                                                                                                                                                                                                   
G9054005004demonstration project)                                                                                                                                                                                                                                                                                               
G9055001003Oncology; primary focus of visit; other, unspecified service not otherwise      Onc visit unspecified nos   00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9055002004listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                        
G9056001003Oncology; practice guidelines; management adheres to guidelines (for use in a   Onc prac mgmt adheres guide 00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9056002004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9057001003Oncology; practice guidelines; management differs from guidelines as a result   Onc pract mgmt differs trial00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9057002004of patient enrollment in an institutional review board approved clinical trial                                                                                                                                                                                                                                       
G9057003004(for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                               
G9058001003Oncology; practice guidelines; management differs from guidelines because the   Onc prac mgmt disagree w/gui00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9058002004treating physician disagrees with guideline recommendations (for use in a                                                                                                                                                                                                                                            
G9058003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9059001003Oncology; practice guidelines; management differs from guidelines because the   Onc prac mgmt pt opt alterna00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9059002004patient, after being offered treatment consistent with guidelines, has opted                                                                                                                                                                                                                                         
G9059003004for alternative treatment or management, including no treatment (for use in a                                                                                                                                                                                                                                        
G9059004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9060001003Oncology; practice guidelines; management differs from guidelines for reason(s) Onc prac mgmt dif pt comorb 00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9060002004associated with patient comorbid illness or performance status not factored                                                                                                                                                                                                                                          
G9060003004into guidelines (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                               
G9061001003Oncology; practice guidelines; patient's condition not addressed by available   Onc prac cond noadd by guide00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9061002004guidelines (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                    
G9062001003Oncology; practice guidelines; management differs from guidelines for other     Onc prac guide differs nos  00      9                                                                                                     I                          P7B 1      02006010120070101        N                           
G9062002004reason(s) not listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                          
G9063001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc stgi no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9063002004disease initially established as stage i (prior to neo-adjuvant therapy, if                                                                                                                                                                                                                                          
G9063003004any) with no evidence of disease progression, recurrence, or metastases (for                                                                                                                                                                                                                                         
G9063004004use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                                    
G9064001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc stg2 no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9064002004disease initially established as stage ii (prior to neo-adjuvant therapy, if                                                                                                                                                                                                                                         
G9064003004any) with no evidence of disease progression, recurrence, or metastases (for                                                                                                                                                                                                                                         
G9064004004use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                                    
G9065001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc stg3a no progre00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9065002004disease initially established as stage iii a (prior to neo-adjuvant therapy, if                                                                                                                                                                                                                                      
G9065003004any) with no evidence of disease progression, recurrence, or metastases (for                                                                                                                                                                                                                                         
G9065004004use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                                    
G9066001003Oncology; disease status; limited to non-small cell lung cancer; stage iii b-   Onc dx nsclc stg3b-4 metasta00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9066002004iv at diagnosis, metastatic, locally recurrent, or progressive (for use in a                                                                                                                                                                                                                                         
G9066003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9067001003Oncology; disease status; limited to non-small cell lung cancer; extent of      Onc dx nsclc dx unknown nos 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9067002004disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                    
G9067003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9068001003Oncology; disease status; limited to small cell and combined small              Onc dx sclc/nsclc limited   00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9068002004cell/non-small cell; extent of disease initially established as limited with no                                                                                                                                                                                                                                      
G9068003004evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                             
G9068004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9069001003Oncology; disease status; small cell lung cancer, limited to small cell and     Onc dx sclc/nsclc ext at dx 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9069002004combined small cell/non-small cell; extensive stage at diagnosis, metastatic,                                                                                                                                                                                                                                        
G9069003004locally recurrent, or progressive (for use in a medicare-approved demonstration                                                                                                                                                                                                                                      
G9069004004project)                                                                                                                                                                                                                                                                                                             
G9070001003Oncology; disease status; small cell lung cancer, limited to small cell and     Onc dx sclc/nsclc ext unknwn00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9070002004combined small cell/non-small; extent of disease unknown, staging in progress,                                                                                                                                                                                                                                       
G9070003004or not listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                 
G9071001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg1-2b hr,nopro00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9071002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i or                                                                                                                                                                                                                                       
G9071003004stage iia-iib; or t3, n1, m0; and er and/or pr positive; with no evidence of                                                                                                                                                                                                                                         
G9071004004disease progression, recurrence, or metastases (for use in a medicare-approved                                                                                                                                                                                                                                       
G9071005004demonstration project)                                                                                                                                                                                                                                                                                               
G9072001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg1-2 noprogres00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9072002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage i, or                                                                                                                                                                                                                                      
G9072003004stage iia-iib; or t3, n1, m0; and er and pr negative; with no evidence of                                                                                                                                                                                                                                            
G9072004004disease progression, recurrence, or metastases (for use in a medicare-approved                                                                                                                                                                                                                                       
G9072005004demonstration project)                                                                                                                                                                                                                                                                                               
G9073001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg3-hr, no pro 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9073002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage                                                                                                                                                                                                                                            
G9073003004iiia-iiib; and not t3, n1, m0; and er and/or pr positive; with no evidence of                                                                                                                                                                                                                                        
G9073004004disease progression, recurrence, or metastases (for use in a medicare-approved                                                                                                                                                                                                                                       
G9073005004demonstration project)                                                                                                                                                                                                                                                                                               
G9074001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst stg3-noprogress 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9074002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage                                                                                                                                                                                                                                            
G9074003004iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of                                                                                                                                                                                                                                           
G9074004004disease progression, recurrence, or metastases (for use in a medicare-approved                                                                                                                                                                                                                                       
G9074005004demonstration project)                                                                                                                                                                                                                                                                                               
G9075001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst metastic/ recur 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9075002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; m1 at                                                                                                                                                                                                                                            
G9075003004diagnosis, metastatic, locally recurrent, or progressive (for use in a                                                                                                                                                                                                                                               
G9075004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9077001003Oncology; disease status; prostate cancer, limited to adenocarcinoma as         Onc dx prostate t1no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9077002004predominant cell type; t1-t2c and gleason 2-7 and psa < or equal to 20 at                                                                                                                                                                                                                                            
G9077003004diagnosis with no evidence of disease progression, recurrence, or metastases                                                                                                                                                                                                                                         
G9077004004(for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                               
G9078001003Oncology; disease status; prostate cancer, limited to adenocarcinoma as         Onc dx prostate t2no progres00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9078002004predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no                                                                                                                                                                                                                                       
G9078003004evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                             
G9078004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9079001003Oncology; disease status; prostate cancer, limited to adenocarcinoma as         Onc dx prostate t3b-t4noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9079002004predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence                                                                                                                                                                                                                                        
G9079003004of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                                      
G9079004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9080001003Oncology; disease status; prostate cancer, limited to adenocarcinoma; after     Onc dx prostate w/rise psa  00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9080002004initial treatment with rising psa or failure of psa decline (for use in a                                                                                                                                                                                                                                            
G9080003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9083001003Oncology; disease status; prostate cancer, limited to adenocarcinoma; extent of Onc dx prostate unknwn nos  00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9083002004disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                    
G9083003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9084001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon t1-3,n1-2,no pr00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9084002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9084003004established as t1-3, n0, m0 with no evidence of disease progression,                                                                                                                                                                                                                                                 
G9084004004recurrence, or metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                     
G9085001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon t4, n0 w/o prog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9085002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9085003004established as t4, n0, m0 with no evidence of disease progression, recurrence,                                                                                                                                                                                                                                       
G9085004004or metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                 
G9086001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon t1-4 no dx prog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9086002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9086003004established as t1-4, n1-2, m0 with no evidence of disease progression,                                                                                                                                                                                                                                               
G9086004004recurrence, or metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                     
G9087001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon metas evid dx  00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9087002004adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally                                                                                                                                                                                                                                        
G9087003004recurrent, or progressive with current clinical, radiologic, or biochemical                                                                                                                                                                                                                                          
G9087004004evidence of disease (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                           
G9088001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon metas noevid dx00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9088002004adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally                                                                                                                                                                                                                                        
G9088003004recurrent, or progressive without current clinical, radiologic, or biochemical                                                                                                                                                                                                                                       
G9088004004evidence of disease (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                           
G9089001003Oncology; disease status; colon cancer, limited to invasive cancer,             Onc dx colon extent unknown 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9089002004adenocarcinoma as predominant cell type; extent of disease unknown, staging in                                                                                                                                                                                                                                       
G9089003004progress, or not listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                       
G9090001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal t1-2 no progr 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9090002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9090003004established as t1-2, n0, m0 (prior to neo-adjuvant therapy, if any) with no                                                                                                                                                                                                                                          
G9090004004evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                             
G9090005004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9091001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal t3 n0 no prog 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9091002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9091003004established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no                                                                                                                                                                                                                                            
G9091004004evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                             
G9091005004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9092001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal t1-3,n1-2noprg00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9092002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9092003004established as t1-3, n1-2, m0 (prior to neo-adjuvant therapy, if any) with no                                                                                                                                                                                                                                        
G9092004004evidence of disease progression, recurrence or metastases (for use in a                                                                                                                                                                                                                                              
G9092005004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9093001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal t4,n,m0 no prg00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9093002004adenocarcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                                 
G9093003004established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no                                                                                                                                                                                                                                         
G9093004004evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                             
G9093005004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9094001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal m1 w/mets prog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9094002004adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally                                                                                                                                                                                                                                        
G9094003004recurrent, or progressive (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                     
G9095001003Oncology; disease status; rectal cancer, limited to invasive cancer,            Onc dx rectal extent unknwn 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9095002004adenocarcinoma as predominant cell type; extent of disease unknown, staging in                                                                                                                                                                                                                                       
G9095003004progress, or not listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                       
G9096001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophag t1-t3 noprog 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9096002004squamous cell carcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                        
G9096003004established as t1-t3, n0-n1 or nx (prior to neo-adjuvant therapy, if any) with                                                                                                                                                                                                                                       
G9096004004no evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                          
G9096005004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9097001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophageal t4 no prog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9097002004squamous cell carcinoma as predominant cell type; extent of disease initially                                                                                                                                                                                                                                        
G9097003004established as t4, any n, m0 (prior to neo-adjuvant therapy, if any) with no                                                                                                                                                                                                                                         
G9097004004evidence of disease progression, recurrence, or metastases (for use in a                                                                                                                                                                                                                                             
G9097005004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9098001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophageal mets recur00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9098002004squamous cell carcinoma as predominant cell type; m1 at diagnosis, metastatic,                                                                                                                                                                                                                                       
G9098003004locally recurrent, or progressive (for use in a medicare-approved demonstration                                                                                                                                                                                                                                      
G9098004004project)                                                                                                                                                                                                                                                                                                             
G9099001003Oncology; disease status; esophageal cancer, limited to adenocarcinoma or       Onc dx esophageal unknown   00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9099002004squamous cell carcinoma as predominant cell type; extent of disease unknown,                                                                                                                                                                                                                                         
G9099003004staging in progress, or not listed (for use in a medicare-approved                                                                                                                                                                                                                                                   
G9099004004demonstration project)                                                                                                                                                                                                                                                                                               
G9100001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric no recurrence00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9100002004predominant cell type; post r0 resection (with or without neoadjuvant therapy)                                                                                                                                                                                                                                       
G9100003004with no evidence of disease recurrence, progression, or metastases (for use in                                                                                                                                                                                                                                       
G9100004004a medicare-approved demonstration project)                                                                                                                                                                                                                                                                           
G9101001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric p r1-r2noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9101002004predominant cell type; post r1 or r2 resection (with or without neoadjuvant                                                                                                                                                                                                                                          
G9101003004therapy) with no evidence of disease progression, or metastases (for use in a                                                                                                                                                                                                                                        
G9101004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9102001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric unresectable 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9102002004predominant cell type; clinical or pathologic m0, unresectable with no evidence                                                                                                                                                                                                                                      
G9102003004of disease progression, or metastases (for use in a medicare-approved                                                                                                                                                                                                                                                
G9102004004demonstration project)                                                                                                                                                                                                                                                                                               
G9103001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric recurrent    00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9103002004predominant cell type; clinical or pathologic m1 at diagnosis, metastatic,                                                                                                                                                                                                                                           
G9103003004locally recurrent, or progressive (for use in a medicare-approved demonstration                                                                                                                                                                                                                                      
G9103004004project)                                                                                                                                                                                                                                                                                                             
G9104001003Oncology; disease status; gastric cancer, limited to adenocarcinoma as          Onc dx gastric unknown nos  00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9104002004predominant cell type; extent of disease unknown, staging in progress, or not                                                                                                                                                                                                                                        
G9104003004listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                        
G9105001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as       Onc dx pancreatc p r0 res no00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9105002004predominant cell type; post r0 resection without evidence of disease                                                                                                                                                                                                                                                 
G9105003004progression, recurrence, or metastases (for use in a medicare-approved                                                                                                                                                                                                                                               
G9105004004demonstration project)                                                                                                                                                                                                                                                                                               
G9106001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; post r1 Onc dx pancreatc p r1/r2 no 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9106002004or r2 resection with no evidence of disease progression, or metastases (for use                                                                                                                                                                                                                                      
G9106003004in a medicare-approved demonstration project)                                                                                                                                                                                                                                                                        
G9107001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma;         Onc dx pancreatic unresectab00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9107002004unresectable at diagnosis, m1 at diagnosis, metastatic, locally recurrent, or                                                                                                                                                                                                                                        
G9107003004progressive (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                   
G9108001003Oncology; disease status; pancreatic cancer, limited to adenocarcinoma; extent  Onc dx pancreatic unknwn nos00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9108002004of disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                 
G9108003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9109001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck t1-t2no prg00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9109002004cavity, pharynx and larynx with squamous cell as predominant cell type; extent                                                                                                                                                                                                                                       
G9109003004of disease initially established as t1-t2 and n0, m0 (prior to neo-adjuvant                                                                                                                                                                                                                                          
G9109004004therapy, if any) with no evidence of disease progression, recurrence, or                                                                                                                                                                                                                                             
G9109005004metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                    
G9110001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck t3-4 noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9110002004cavity, pharynx and larynx with squamous cell as predominant cell type; extent                                                                                                                                                                                                                                       
G9110003004of disease initially established as t3-4 and/or n1-3, m0 (prior to neo-adjuvant                                                                                                                                                                                                                                      
G9110004004therapy, if any) with no evidence of disease progression, recurrence, or                                                                                                                                                                                                                                             
G9110005004metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                    
G9111001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck m1 mets rec00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9111002004cavity, pharynx and larynx with squamous cell as predominant cell type; m1 at                                                                                                                                                                                                                                        
G9111003004diagnosis, metastatic, locally recurrent, or progressive (for use in a                                                                                                                                                                                                                                               
G9111004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9112001003Oncology; disease status; head and neck cancer, limited to cancers of oral      Onc dx head/neck ext unknown00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9112002004cavity, pharynx and larynx with squamous cell as predominant cell type; extent                                                                                                                                                                                                                                       
G9112003004of disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                 
G9112004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9113001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian stg1a-b no pr00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9113002004pathologic stage ia-b (grade 1) without evidence of disease progression,                                                                                                                                                                                                                                             
G9113003004recurrence, or metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                     
G9114001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian stg1a-b or 2 00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9114002004pathologic stage ia-b (grade 2-3); or stage ic (all grades); or stage ii;                                                                                                                                                                                                                                            
G9114003004without evidence of disease progression, recurrence, or metastases (for use in                                                                                                                                                                                                                                       
G9114004004a medicare-approved demonstration project)                                                                                                                                                                                                                                                                           
G9115001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian stg3/4 noprog00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9115002004pathologic stage iii-iv; without evidence of progression, recurrence, or                                                                                                                                                                                                                                             
G9115003004metastases (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                    
G9116001003Oncology; disease status; ovarian cancer, limited to epithelial cancer;         Onc dx ovarian recurrence   00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9116002004evidence of disease progression, or recurrence, and/or platinum resistance (for                                                                                                                                                                                                                                      
G9116003004use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                                    
G9117001003Oncology; disease status; ovarian cancer, limited to epithelial cancer; extent  Onc dx ovarian unknown nos  00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9117002004of disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                 
G9117003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9123001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx cml chronic phase    00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9123002004chromosome positive and/or bcr-abl positive; chronic phase not in hematologic,                                                                                                                                                                                                                                       
G9123003004cytogenetic, or molecular remission (for use in a medicare-approved                                                                                                                                                                                                                                                  
G9123004004demonstration project)                                                                                                                                                                                                                                                                                               
G9124001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx cml acceler phase    00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9124002004chromosome positive and/or bcr-abl positive; accelerated phase not in                                                                                                                                                                                                                                                
G9124003004hematologic cytogenetic, or molecular remission (for use in a medicare-approved                                                                                                                                                                                                                                      
G9124004004demonstration project)                                                                                                                                                                                                                                                                                               
G9125001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx cml blast phase      00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9125002004chromosome positive and/or bcr-abl positive; blast phase not in hematologic,                                                                                                                                                                                                                                         
G9125003004cytogenetic, or molecular remission (for use in a medicare-approved                                                                                                                                                                                                                                                  
G9125004004demonstration project)                                                                                                                                                                                                                                                                                               
G9126001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx cml remission        00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9126002004chromosome positive and/or bcr-abl positive; in hematologic, cytogenetic, or                                                                                                                                                                                                                                         
G9126003004molecular remission (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                           
G9128001003Oncology; disease status; limited to multiple myeloma, systemic disease;        Onc dx multi myeloma stage i00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9128002004smoldering, stage i (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                           
G9129001003Oncology; disease status; limited to multiple myeloma, systemic disease; stage  Onc dx mult myeloma stg2 hig00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9129002004ii or higher (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                                  
G9130001003Oncology; disease status; limited to multiple myeloma, systemic disease; extent Onc dx multi myeloma unknown00      9                                                                                                     C                          P7B 1      02006010120070101        N                           
G9130002004of disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                 
G9130003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9131001003Oncology; disease status; invasive female breast cancer (does not include       Onc dx brst unknown nos     00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9131002004ductal carcinoma in situ); adenocarcinoma as predominant cell type; extent of                                                                                                                                                                                                                                        
G9131003004disease unknown, staging in progress, or not listed (for use in a                                                                                                                                                                                                                                                    
G9131004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9132001003Oncology; disease status; prostate cancer, limited to adenocarcinoma;           Onc dx prostate mets no cast00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9132002004hormone-refractory/androgen-independent (e.g., rising psa on anti-androgen                                                                                                                                                                                                                                           
G9132003004therapy or post-orchiectomy); clinical metastases (for use in a                                                                                                                                                                                                                                                      
G9132004004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9133001003Oncology; disease status; prostate cancer, limited to adenocarcinoma;           Onc dx prostate clinical met00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9133002004hormone-responsive; clinical metastases or m1 at diagnosis (for use in a                                                                                                                                                                                                                                             
G9133003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9134001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc nhlstg 1-2 no relap no  00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9134002004stage i, ii at diagnosis, not relapsed, not refractory (for use in a                                                                                                                                                                                                                                                 
G9134003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9135001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc dx nhl stg 3-4 not relap00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9135002004stage iii, iv, not relapsed, not refractory (for use in a medicare-approved                                                                                                                                                                                                                                          
G9135003004demonstration project)                                                                                                                                                                                                                                                                                               
G9136001003Oncology; disease status; non-hodgkin's lymphoma, transformed from original     Onc dx nhl trans to lg bcell00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9136002004cellular diagnosis to a second cellular classification (for use in a                                                                                                                                                                                                                                                 
G9136003004medicare-approved demonstration project)                                                                                                                                                                                                                                                                             
G9137001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc dx nhl relapse/refractor00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9137002004relapsed/refractory (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                           
G9138001003Oncology; disease status; non-hodgkin's lymphoma, any cellular classification;  Onc dx nhl stg unknown      00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9138002004diagnostic evaluation, stage not determined, evaluation of possible relapse or                                                                                                                                                                                                                                       
G9138003004non-response to therapy, or not listed (for use in a medicare-approved                                                                                                                                                                                                                                               
G9138004004demonstration project)                                                                                                                                                                                                                                                                                               
G9139001003Oncology; disease status; chronic myelogenous leukemia, limited to philadelphia Onc dx cml dx status unknown00      9                                                                                                     C                          P7B 1      02007010120070101        N                           
G9139002004chromosome positive and/or bcr-abl positive; extent of disease unknown, staging                                                                                                                                                                                                                                      
G9139003004in progress, not listed (for use in a medicare-approved demonstration project)                                                                                                                                                                                                                                       
G9140001003Frontier extended stay clinic demonstration; for a patient stay in a clinic     Frontier extended stay demo 00      9                                                                                                     C                          Z2  1      02007100120071001        N                           
G9140002004approved for the cms demonstration project; the following measures should be                                                                                                                                                                                                                                         
G9140003004present: the stay must be equal to or greater than 4 hours; weather or other                                                                                                                                                                                                                                         
G9140004004conditions must prevent transfer or the case falls into a category of                                                                                                                                                                                                                                                
G9140005004monitoring and observation cases that are permitted by the rules of the                                                                                                                                                                                                                                              
G9140006004demonstration; there is a maximum frontier extended stay clinic (fesc) visit of                                                                                                                                                                                                                                      
G914000700448 hours, except in the case when weather or other conditions prevent transfer;                                                                                                                                                                                                                                      
G9140008004payment is made on each period up to 4 hours, after the first 4 hours                                                                                                                                                                                                                                                
G9143001003Warfarin responsiveness testing by genetic technique using any method, any      Warfarin respon genetic test1321    A                                                    220400                                           C                          M5D 1      02009080320140101        N                           
G9143002004number of specimen(s)                                                                                                                                                                                                                                                                                                
G9147001003Outpatient intravenous insulin treatment (oivit) either pulsatile or            Outpt iv insulin tx any mea 00      9                                                                                                     M                      0172P5E 9      02009122320091223        N                           
G9147002004continuous, by any means, guided by the results of measurements for:                                                                                                                                                                                                                                                 
G9147003004respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial,                                                                                                                                                                                                                                           
G9147004004venous or capillary glucose; and/or potassium concentration                                                                                                                                                                                                                                                          
G9148001003National committee for quality assurance - level 1 medical home                 Medical home level 1        00      9                                                                                                     C                          Z2  1      02011070120110701        N                           
G9149001003National committee for quality assurance - level 2 medical home                 Medical home level ii       00      9                                                                                                     C                          Z2  1      02011070120110701        N                           
G9150001003National committee for quality assurance - level 3 medical home                 Medical home level iii      00      9                                                                                                     C                          Z2  1      02011070120110701        N                           
G9151001003Mapcp demonstration - state provided services                                   Mapcp demo state            00      9                                                                                                     C                          Z2  1      02011070120110701        N                           
G9152001003Mapcp demonstration - community health teams                                    Mapcp demo community        00      9                                                                                                     C                          Z2  1      02011070120110701        N                           
G9153001003Mapcp demonstration - physician incentive pool                                  Mapcp demo physician        00      9                                                                                                     C                          Z2  1      02011070120110701        N                           
G9156001003Evaluation for wheelchair requiring face to face visit with physician           Evaluation for wheelchair   00      9                                                                                                     C                          Z2  1      02012010120120101        N                           
G9157001003Transesophageal doppler measurement of cardiac output (including probe          Transesoph doppl cardiac mon00      9                                                                                                     C                          T2C 1      02013010120130101        N                           
G9157002004placement, image acquisition, and interpretation per course of treatment) for                                                                                                                                                                                                                                        
G9157003004monitoring purposes                                                                                                                                                                                                                                                                                                  
G9158001003Motor speech functional limitation, discharge status, at discharge from therapy Motor speech d/c status     00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9158002004or to end reporting                                                                                                                                                                                                                                                                                                  
G9159001003Spoken language comprehension functional limitation, current status at therapy  Lang comp current status    00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9159002004episode outset and at reporting intervals                                                                                                                                                                                                                                                                            
G9160001003Spoken language comprehension functional limitation, projected goal status at   Lang comp goal status       00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9160002004therapy episode outset, at reporting intervals, and at discharge or to end                                                                                                                                                                                                                                           
G9160003004reporting                                                                                                                                                                                                                                                                                                            
G9161001003Spoken language comprehension functional limitation, discharge status, at       Lang comp d/c status        00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9161002004discharge from therapy or to end reporting                                                                                                                                                                                                                                                                           
G9162001003Spoken language expression functional limitation, current status at therapy     Lang express current status 00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9162002004episode outset and at reporting intervals                                                                                                                                                                                                                                                                            
G9163001003Spoken language expression functional limitation, projected goal status at      Lang express goal status    00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9163002004therapy episode outset, at reporting intervals, and at discharge or to end                                                                                                                                                                                                                                           
G9163003004reporting                                                                                                                                                                                                                                                                                                            
G9164001003Spoken language expression functional limitation, discharge status at discharge Lang express d/c status     00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9164002004from therapy or to end reporting                                                                                                                                                                                                                                                                                     
G9165001003Attention functional limitation, current status at therapy episode outset and   Atten current status        00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9165002004at reporting intervals                                                                                                                                                                                                                                                                                               
G9166001003Attention functional limitation, projected goal status at therapy episode       Atten goal status           00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9166002004outset, at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                                 
G9167001003Attention functional limitation, discharge status at discharge from therapy or  Atten d/c status            00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9167002004to end reporting                                                                                                                                                                                                                                                                                                     
G9168001003Memory functional limitation, current status at therapy episode outset and at   Memory current status       00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9168002004reporting intervals                                                                                                                                                                                                                                                                                                  
G9169001003Memory functional limitation, projected goal status at therapy episode outset,  Memory goal status          00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9169002004at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                                         
G9170001003Memory functional limitation, discharge status at discharge from therapy or to  Memory d/c status           00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9170002004end reporting                                                                                                                                                                                                                                                                                                        
G9171001003Voice functional limitation, current status at therapy episode outset and at    Voice current status        00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9171002004reporting intervals                                                                                                                                                                                                                                                                                                  
G9172001003Voice functional limitation, projected goal status at therapy episode outset,   Voice goal status           00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9172002004at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                                         
G9173001003Voice functional limitation, discharge status at discharge from therapy or to   Voice d/c status            00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9173002004end reporting                                                                                                                                                                                                                                                                                                        
G9174001003Other speech language pathology functional limitation, current status at        Speech lang current status  00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9174002004therapy episode outset and at reporting intervals                                                                                                                                                                                                                                                                    
G9175001003Other speech language pathology functional limitation, projected goal status at Speech lang goal status     00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9175002004therapy episode outset, at reporting intervals, and at discharge or to end                                                                                                                                                                                                                                           
G9175003004reporting                                                                                                                                                                                                                                                                                                            
G9176001003Other speech language pathology functional limitation, discharge status at      Speech lang d/c status      00      9                                                                                                     C                          M5D 1      02013010120140101        N                           
G9176002004discharge from therapy or to end reporting                                                                                                                                                                                                                                                                           
G9186001003Motor speech functional limitation, projected goal status at therapy episode    Motor speech goal status    00      9                                                                                                     C                          M5D 1      02013010120150101        N                           
G9186002004outset, at reporting intervals, and at discharge or to end reporting                                                                                                                                                                                                                                                 
G9187001003Bundled payments for care improvement initiative home visit for patient         Bpci home visit             13      A                                                                                                     C                          M5D 1      02013100120131001        N                           
G9187002004assessment performed by a qualified health care professional for individuals                                                                                                                                                                                                                                         
G9187003004not considered homebound including, but not limited to, assessment of safety,                                                                                                                                                                                                                                        
G9187004004falls, clinical status, fluid status, medication reconciliation/management,                                                                                                                                                                                                                                          
G9187005004patient compliance with orders/plan of care, performance of activities of daily                                                                                                                                                                                                                                      
G9187006004living, appropriateness of care setting; (for use only in the meidcare-approved                                                                                                                                                                                                                                      
G9187007004bundled payments for care improvement initiative); may not be billed for a                                                                                                                                                                                                                                           
G918700800430-day period covered by a transitional care management code                                                                                                                                                                                                                                                         
G9188001003Beta-blocker therapy not prescribed, reason not given                           Beta not given no reason    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9189001003Beta-blocker therapy prescribed or currently being taken                        Beta pres or already taking 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9190001003Documentation of medical reason(s) for not prescribing beta-blocker therapy     Medical reason for no beta  00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9190002004(eg, allergy, intolerance, other medical reasons)                                                                                                                                                                                                                                                                    
G9191001003Documentation of patient reason(s) for not prescribing beta-blocker therapy     Pt reason for no beta       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9191002004(eg, patient declined, other patient reasons)                                                                                                                                                                                                                                                                        
G9192001003Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, System reason for no beta   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9192002004other reasons attributable to the health care system)                                                                                                                                                                                                                                                                
G9193001003Clinician documented that patient with a diagnosis of major depression was not  Doc not eligible for dep med00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9193002004an eligible candidate for antidepressant medication treatment or patient did                                                                                                                                                                                                                                         
G9193003004not have a diagnosis of major depression                                                                                                                                                                                                                                                                             
G9194001003Patient with a diagnosis of major depression documented as being treated with   Mdd pt treated for 180d     00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9194002004antidepressant medication during the entire 180 day (6 month) continuation                                                                                                                                                                                                                                           
G9194003004treatment phase                                                                                                                                                                                                                                                                                                      
G9195001003Patient with a diagnosis of major depression not documented as being treated    Mdd pt not treated for 180d 00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9195002004with antidepressant medication during the entire 180 day (6 months)                                                                                                                                                                                                                                                  
G9195003004continuation treatment phase                                                                                                                                                                                                                                                                                         
G9196001003Documentation of medical reason(s) for not ordering a first or second           Med reason for no ceph      00      9                                                                                                     C                          M5B 1      02014010120160101        N                           
G9196002004generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled                                                                                                                                                                                                                                      
G9196003004in clinical trials, patients with documented infection prior to surgical                                                                                                                                                                                                                                             
G9196004004procedure of interest, patients who were receiving antibiotics more than 24                                                                                                                                                                                                                                          
G9196005004hours prior to surgery [except colon surgery patients taking oral prophylactic                                                                                                                                                                                                                                       
G9196006004antibiotics], patients who were receiving antibiotics within 24 hours prior to                                                                                                                                                                                                                                       
G9196007004arrival [except colon surgery patients taking oral prophylactic antibiotics],                                                                                                                                                                                                                                        
G9196008004other medical reason(s))                                                                                                                                                                                                                                                                                             
G9197001003Documentation of order for first or second generation cephalosporin for         Order for ceph              00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9197002004antimicrobial prophylaxis                                                                                                                                                                                                                                                                                            
G9198001003Order for first or second generation cephalosporin for antimicrobial            No order for ceph no reason 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9198002004prophylaxis was not documented, reason not given                                                                                                                                                                                                                                                                     
G9199001003Venous thromboembolism (vte) prophylaxis not administered the day of or the day Doc reason for no vte       00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9199002004after hospital admission for documented reasons (eg, patient is ambulatory,                                                                                                                                                                                                                                          
G9199003004patient expired during inpatient stay, patient already on warfarin or another                                                                                                                                                                                                                                        
G9199004004anticoagulant, other medical reason(s) or eg, patient left against medical                                                                                                                                                                                                                                           
G9199005004advice, other patient reason(s))                                                                                                                                                                                                                                                                                     
G9200001003Venous thromboembolism (vte) prophylaxis was not administered the day of or the No reason for no vte        00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9200002004day after hospital admission, reason not given                                                                                                                                                                                                                                                                       
G9201001003Venous thromboembolism (vte) prophylaxis administered the day of or the day     Vte given upon admission    00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9201002004after hospital admission                                                                                                                                                                                                                                                                                             
G9202001003Patients with a positive hepatitis c antibody test                              Hep c aby pos               00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9203001003Rna testing for hepatitis c documented as performed within 12 months prior to   Hep c rna done prior to med 00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9203002004initiation of antiviral treatment for hepatitis c                                                                                                                                                                                                                                                                    
G9204001003Rna testing for hepatitis c was not documented as performed within 12 months    No reason for no hep c rna  00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9204002004prior to initiation of antiviral treatment for hepatitis c, reason not given                                                                                                                                                                                                                                         
G9205001003Patient starting antiviral treatmentfor hepatitis c during the measurement      Hep c antiviral started     00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9205002004period                                                                                                                                                                                                                                                                                                               
G9206001003Patient starting antiviral treatment for hepatitis c during the measurement     Hep c therapy started       00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9206002004period                                                                                                                                                                                                                                                                                                               
G9207001003Hepatitis c genotype testing documented as performed within 12 months prior to  Hep c genotype prior to med 00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9207002004initiation of antiviral treatment for hepatitis c                                                                                                                                                                                                                                                                    
G9208001003Hepatitis c genotype testing was not documented as performed within 12 months   No reason for no hep c geno 00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9208002004prior to initiation of antiviral treatment for hepatitis c, reason not given                                                                                                                                                                                                                                         
G9209001003Hepatitis c quantitative rna testing documented as performed between 4-12 weeks Hep c rna 4to12 wk after med00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9209002004after the initiation of antiviral treatment                                                                                                                                                                                                                                                                          
G9210001003Hepatitis c quantitative rna testing not performed between 4-12 weeks after the No hepc rna after med docrsn00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9210002004initiation of antiviral treatment for documented reason(s) (e.g., patients                                                                                                                                                                                                                                           
G9210003004whose treatment was discontinued during the testing period prior to testing,                                                                                                                                                                                                                                         
G9210004004other medical reasons, patient declined, other patient reasons)                                                                                                                                                                                                                                                      
G9211001003Hepatitis c quantitative rna testing was not documented as performed between    No hepc rna after med no rsn00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G92110020044-12 weeks after the initiation of antiviral treatment, reason not given                                                                                                                                                                                                                                             
G9212001003Dsm-ivtm criteria for major depressive disorder documented at the initial       Doc of dsm-iv init eval     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9212002004evaluation                                                                                                                                                                                                                                                                                                           
G9213001003Dsm-iv-tr criteria for major depressive disorder not documented at the initial  No doc of dsm-iv            00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9213002004evaluation, reason not otherwise specified                                                                                                                                                                                                                                                                           
G9214001003Cd4+ cell count or cd4+ cell percentage results documented                      Cd4 count documented        00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9215001003Cd4+ cell count or percentage not documented as performed, reason not given     No cd4 count no reason      00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9216001003Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not givenNo pcp proph at dx no reason00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9217001003Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below No pcp proph low cd4 norsn  00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9217002004200 cells/mm3, reason not given                                                                                                                                                                                                                                                                                      
G9218001003Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below  No pcp prop low at cd4 norsn00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9218002004500 cells/mm3 or a cd4 percentage below 15%, reason not given                                                                                                                                                                                                                                                        
G9219001003Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of   No oder pjp for med reason  00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9219002004low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's                                                                                                                                                                                                                                          
G9219003004cd4+ cell count above threshold within 3 months after cd4+ cell count below                                                                                                                                                                                                                                          
G9219004004threshold, indicating that the patient's cd4+ levels are within an acceptable                                                                                                                                                                                                                                        
G9219005004range and the patient does not require pcp prophylaxis)                                                                                                                                                                                                                                                              
G9220001003Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of   No order for pjp for medrsn 00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9220002004low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for                                                                                                                                                                                                                                            
G9220003004medical reason (i.e., patient's cd4+ cell count above threshold within 3 months                                                                                                                                                                                                                                      
G9220004004after cd4+ cell count below threshold, indicating that the patient's cd4+                                                                                                                                                                                                                                            
G9220005004levels are within an acceptable range and the patient does not require pcp                                                                                                                                                                                                                                           
G9220006004prophylaxis)                                                                                                                                                                                                                                                                                                         
G9221001003Pneumocystis jiroveci pneumonia prophlaxis prescribed                           Pjp proph prescribed        00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9222001003Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low    Pjp proph ordered low cd4   00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9222002004cd4+ cell count below 200 cells/mm3                                                                                                                                                                                                                                                                                  
G9223001003Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low   Pjp proph ordered cd4 low   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9223002004cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%                                                                                                                                                                                                                                                    
G9224001003Documentation of medical reason for not performing foot exam (e.g., patient     Medrsn no foot exam         00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9224002004with bilateral foot/leg amputation)                                                                                                                                                                                                                                                                                  
G9225001003Foot exam was not performed, reason not given                                   Norsn no foot exam          00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9226001003Foot examination performed (includes examination through visual inspection,     3 comp foot exam completed  00      9                                                                                                     C                          M5B 1      02014010120160101        N                           
G9226002004sensory exam with 10-g monofilament plus testing any one of the following:                                                                                                                                                                                                                                           
G9226003004vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or                                                                                                                                                                                                                                           
G9226004004vibration perception threshold, and pulse exam; report when all of the 3                                                                                                                                                                                                                                             
G9226005004components are completed)                                                                                                                                                                                                                                                                                            
G9227001003Functional outcome assessment documented, care plan not documented,             Foa doc, care plan not doc  00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9227002004documentation the patient is not eligible for a care plan at the time of the                                                                                                                                                                                                                                         
G9227003004encounter                                                                                                                                                                                                                                                                                                            
G9228001003Chlamydia, gonorrhea and syphilis screening results documented (report when     Gc chl syp documented       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9228002004results are present for all of the 3 screenings)                                                                                                                                                                                                                                                                     
G9229001003Chlamydia, gonorrhea, and syphilis screening results not documented (patient    Ptrsn no gc chl syp test    00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9229002004refusal is the only allowed exception)                                                                                                                                                                                                                                                                               
G9230001003Chlamydia, gonorrhea, and syphilis not screened, reason not given               Norsn for gc chl syp test   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9231001003Documentation of end stage renal disease (esrd), dialysis, renal transplant     Doc esrd dia trans preg     00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9231002004before or during the measurement period or pregnancy during the measurement                                                                                                                                                                                                                                          
G9231003004period                                                                                                                                                                                                                                                                                                               
G9232001003Clinician treating major depressive disorder did not communicate to clinician   Ptrsn no comm comorbid      00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9232002004treating comorbid condition for specified patient reason (e.g., patient is                                                                                                                                                                                                                                           
G9232003004unable to communicate the diagnosis of a comorbid condition; the patient is                                                                                                                                                                                                                                          
G9232004004unwilling to communicate the diagnosis of a comorbid condition; or the patient                                                                                                                                                                                                                                       
G9232005004is unaware of the comorbid condition, or any other specified patient reason)                                                                                                                                                                                                                                         
G9233001003All quality actions for the applicable measures in the total knee replacement   Tkr composite               00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9233002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G9234001003I intend to report the total knee replacement measures group                    Tkr intent                  00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9235001003All quality actions for the applicable measures in the general surgery measures Gs mg composite             00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9235002004group have been performed for this patient                                                                                                                                                                                                                                                                           
G9236001003All quality actions for the applicable measures in the optimizing patient       Op rad mg composite         00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9236002004exposure to ionizing radiation measures group have been performed for this                                                                                                                                                                                                                                           
G9236003004patient                                                                                                                                                                                                                                                                                                              
G9237001003I intend to report the general surgery measures group                           Gs mg intent                00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9238001003I intend to report the optimizing patient exposure to ionizing radiation        Op rad mg intent            00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9238002004measures group                                                                                                                                                                                                                                                                                                       
G9239001003Documentation of reasons for patient initiaiting maintenance hemodialysis with  Doc rsn hemod & cath acc    00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9239002004a catheter as the mode of vascular access (e.g., patient has a maturing                                                                                                                                                                                                                                              
G9239003004avf/avg, time-limited trial of hemodialysis, other medical reasons, patient                                                                                                                                                                                                                                          
G9239004004declined avf/avg, other patient reasons, patient followed by reporting                                                                                                                                                                                                                                               
G9239005004nephrologist for fewer than 90 days, other system reasons)                                                                                                                                                                                                                                                           
G9240001003Patient whose mode of vascular access is a catheter at the time maintenance     Doc pt w cath maint dia     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9240002004hemodialysis is initiated                                                                                                                                                                                                                                                                                            
G9241001003Patient whose mode of vascular access is not a catheter at the time maintenance Doc pt w out cath maint dia 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9241002004hemodialysis is initiated                                                                                                                                                                                                                                                                                            
G9242001003Documentation of viral load equal to or greater than 200 copies/ml or viral     Doc viral load >=200        00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9242002004load not performed                                                                                                                                                                                                                                                                                                   
G9243001003Documentation of viral load less than 200 copies/ml                             Doc viral load <200         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9244001003Antiretroviral thereapy not prescribed                                          Antiviral not ordered       00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9245001003Antiretroviral therapy prescribed                                               Antiviral ordered           00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9246001003Patient did not have at least one medical visit in each 6 month period of the   No med visit in 24mo        00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G924600200424 month measurement period, with a minimum of 60 days between medical visits                                                                                                                                                                                                                                        
G9247001003Patient had at least one medical visit in each 6 month period of the 24 month   1 med visit in 24mo         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9247002004measurement period, with a minimum of 60 days between medical visits                                                                                                                                                                                                                                                 
G9248001003Patient did not have a medical visit in the last 6 months                       No med visit 6mo            00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9249001003Patient had a medical visit in the last 6 months                                Med visit w in 6mo          00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9250001003Documentation of patient pain brought to a comfortable level within 48 hours    Doc of pain comfort 48hr    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9250002004from initial assessment                                                                                                                                                                                                                                                                                              
G9251001003Documentation of patient with pain not brought to a comfortable level within 48 Doc no pain comfort 48hr    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9251002004hours from initial assessment                                                                                                                                                                                                                                                                                        
G9252001003Adenoma(s) or other neoplasm detected during screening colonoscopy              Neo detect scrn colo        00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9253001003Adenoma(s) or other neoplasm not detected during screening colonoscopy          No neo detect scrn colo     00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9254001003Documentation of patient discharged to home later than post-operative day 2     Doc pt dischg >2d           00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9254002004following cas                                                                                                                                                                                                                                                                                                        
G9255001003Documentation of patient discharged to home no later than post operative day 2  Doc pt dischg <=2d          00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9255002004following cas                                                                                                                                                                                                                                                                                                        
G9256001003Documentation of patient death following cas                                    Doc of pat death after cas  00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9257001003Documentation of patient stroke following cas                                   Doc of pat stroke after cas 00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9258001003Documentation of patient stroke following cea                                   Doc of pat stroke after cea 00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9259001003Documentation of patient survival and absence of stroke following cas           Survive/no stroke post cas  00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9260001003Documentation of patient death following cea                                    Doc of pat death after cea  00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9261001003Documentation of patient survival and absence of stroke following cea           Survive/no stroke post cea  00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9262001003Documentation of patient death in the hospital following endovascular aaa repairDoc of death post-aaa repair00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9263001003Documentation of patient discharged alive following endovascular aaa repair     Doc of disch post-aaa repair00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9264001003Documentation of patient receiving maintenance hemodialysis for greater than or Doc rsn hemod w/cath >=90d  00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9264002004equal to 90 days with a catheter for documented reasons (e.g., other medical                                                                                                                                                                                                                                         
G9264003004reasons, patient declined avf/avg, other patient reasons)                                                                                                                                                                                                                                                            
G9265001003Patient receiving maintenance hemodialysis for greater than or equal to 90 days Doc cath >90d for maint dia 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9265002004with a catheter as the mode of vascular access                                                                                                                                                                                                                                                                       
G9266001003Patient receiving maintenance hemodialysis for greater than or equal to 90 days Norsn pt cath >=90d         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9266002004without a catheter as the mode of vascular access                                                                                                                                                                                                                                                                    
G9267001003Documentation of patient with one or more complications or mortality within 30  Doc comp or mort w in 30d   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9267002004days                                                                                                                                                                                                                                                                                                                 
G9268001003Documentation of patient with one or more complications within 90 days          Doc comp or mort w in 90d   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9269001003Documentation of patient without one or more complications and without          Doc no comp or mort w in 30d00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9269002004mortality within 30 days                                                                                                                                                                                                                                                                                             
G9270001003Documentation of patient without one or more complications within 90 days       Doc no comp or mort w in 90d00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9271001003Ldl value < 100                                                                 Ldl under 100               00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9272001003Ldl value >= 100                                                                Ldl 100 and over            00      9                                                                                                     C                          M5B 1      0201401012015010120141231N                           
G9273001003Blood pressure has a systolic value of < 140 and a diastolic value of < 90      Sys<140 and dia<90          00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9274001003Blood pressure has a systolic value of =140 and a diastolic value of = 90 or    Bp out of nrml limits       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9274002004systolic value < 140 and diastolic value = 90 or systolic value = 140 and                                                                                                                                                                                                                                            
G9274003004diastolic value < 90                                                                                                                                                                                                                                                                                                 
G9275001003Documentation that patient is a current non-tobacco user                        Doc of non tobacco user     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9276001003Documentation that patient is a current tobacco user                            Doc of tobacco user         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9277001003Documentation that the patient is on daily aspirin or anti-platelet or has      Doc daily aspirin or contra 00      9                                                                                                     C                          M5B 1      02014010120160101        N                           
G9277002004documentation of a valid contraindication or exception to                                                                                                                                                                                                                                                            
G9277003004aspirin/anti-platelet; contraindications/exceptions include anti-coagulant use,                                                                                                                                                                                                                                      
G9277004004allergy to aspirin or anti-platelets, history of gastrointestinal bleed and                                                                                                                                                                                                                                          
G9277005004bleeding disorder; additionally, the following exceptions documented by the                                                                                                                                                                                                                                          
G9277006004physician as a reason for not taking daily aspirin or anti-platelet are                                                                                                                                                                                                                                              
G9277007004acceptable (use of non-steroidal anti-inflammatory agents, documented risk for                                                                                                                                                                                                                                       
G9277008004drug interaction, uncontrolled hypertension defined as >180 systolic or >110                                                                                                                                                                                                                                         
G9277009004diastolic or gastroesophageal reflux)                                                                                                                                                                                                                                                                                
G9278001003Documentation that the patient is not on daily aspirin or anti-platelet regimen Doc no daily aspirin        00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9279001003Pneumococcal screening performed and documentation of vaccination received      Pne scrn done doc vac done  00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9279002004prior to discharge                                                                                                                                                                                                                                                                                                   
G9280001003Pneumococcal vaccination not administered prior to discharge, reason not        Pne not given norsn         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9280002004specified                                                                                                                                                                                                                                                                                                            
G9281001003Screening performed and documentation that vaccination not indicated/patient    Pne scrn done doc not ind   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9281002004refusal                                                                                                                                                                                                                                                                                                              
G9282001003Documentation of medical reason(s) for not reporting the histological type or   Doc medrsn no histo type    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9282002004nsclc-nos classification with an explanation (e.g., biopsy taken for other                                                                                                                                                                                                                                           
G9282003004purposes in a patient with a history of non-small cell lung cancer or other                                                                                                                                                                                                                                          
G9282004004documented medical reasons)                                                                                                                                                                                                                                                                                          
G9283001003Non small cell lung cancer biopsy and cytology specimen report documents        Hist type doc on report     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9283002004classification into specific histologic type or classified as nsclc-nos with an                                                                                                                                                                                                                                      
G9283003004explanation                                                                                                                                                                                                                                                                                                          
G9284001003Non small cell lung cancer biopsy and cytology specimen report does not         No hist type doc on report  00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9284002004document classification into specific histologic type or classified as                                                                                                                                                                                                                                               
G9284003004nsclc-nos with an explanation                                                                                                                                                                                                                                                                                        
G9285001003Specimen site other than anatomic location of lung or is not classified as non  Site not small cell lung ca 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9285002004small cell lung cancer                                                                                                                                                                                                                                                                                               
G9286001003Antibiotic regimen prescribed within 10 days after onset of symptoms            Antibio rx w in 10d of sympt00      9                                                                                                     C                          M5B 1      02014010120160101        N                           
G9287001003Antibiotic regimen not prescribed within 10 days after onset of symptoms        No antibio w in 10d of sympt00      9                                                                                                     C                          M5B 1      02014010120160101        N                           
G9288001003Documentation of medical reason(s) for not reporting the histological type or   Doc medrsn no hist type rpt 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9288002004nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in                                                                                                                                                                                                                                      
G9288003004a person with a history of non-small cell carcinoma or other documented medical                                                                                                                                                                                                                                      
G9288004004reasons)                                                                                                                                                                                                                                                                                                             
G9289001003Non small cell lung cancer biopsy and cytology specimen report documents        Doc type nsm lung ca        00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9289002004classification into specific histologic type or classified as nsclc-nos with an                                                                                                                                                                                                                                      
G9289003004explanation                                                                                                                                                                                                                                                                                                          
G9290001003Non small cell lung cancer biopsy and cytology specimen report does not         No doc type nsm lung ca     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9290002004document classification into specific histologic type or classified as                                                                                                                                                                                                                                               
G9290003004nsclc-nos with an explanation                                                                                                                                                                                                                                                                                        
G9291001003Specimen site other than anatomic location of lung, is not classified as non    Not nsm lung ca             00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9291002004small cell lung cancer or classified as nsclc-nos                                                                                                                                                                                                                                                                    
G9292001003Documentation of medical reason(s) for not reporting pt category and a          Medrsn no pt category       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9292002004statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative                                                                                                                                                                                                                                      
G9292003004skin biopsies in a patient with a history of melanoma or other documented                                                                                                                                                                                                                                            
G9292004004medical reasons)                                                                                                                                                                                                                                                                                                     
G9293001003Pathology report does not include the pt category and a statement on thickness  No pt category on report    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9293002004and ulceration and for pt1, mitotic rate                                                                                                                                                                                                                                                                             
G9294001003Pathology report includes the pt category and a statement on thickness and      Pt cat and thck on report   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9294002004ulceration and for pt1, mitotic rate                                                                                                                                                                                                                                                                                 
G9295001003Specimen site other than anatomic cutaneous location                            Non cutaneous loc           00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9296001003Patients with documented shared decision-making including discussion of         Doc share dec prior proc    00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9296002004conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss,                                                                                                                                                                                                                                          
G9296003004exercise, injections) prior to the procedure                                                                                                                                                                                                                                                                         
G9297001003Shared decision-making including discussion of conservative (non-surgical)      No doc share dec prior proc 00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9297002004therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to                                                                                                                                                                                                                                       
G9297003004the procedure, not documented, reason not given                                                                                                                                                                                                                                                                      
G9298001003Patients who are evaluated for venous thromboembolic and cardiovascular risk    Eval risk vte card 30d prior00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9298002004factors within 30 days prior to the procedure (e.g., history of dvt, pe, mi,                                                                                                                                                                                                                                         
G9298003004arrhythmia and stroke)                                                                                                                                                                                                                                                                                               
G9299001003Patients who are not evaluated for venous thromboembolic and cardiovascular     No eval riskk vte card prior00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9299002004risk factors within 30 days prior to the procedure including (e.g., history of                                                                                                                                                                                                                                       
G9299003004dvt, pe, mi, arrhythmia and stroke, reason not given)                                                                                                                                                                                                                                                                
G9300001003Documentation of medical reason(s) for not completely infusing the prophylactic Doc medrsn no compl antibio 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9300002004antibiotic prior to the inflation of the proximal tourniquet (e.g., a                                                                                                                                                                                                                                                
G9300003004tourniquet was not used)                                                                                                                                                                                                                                                                                             
G9301001003Patients who had the prophylactic antibiotic completely infused prior to the    Doc compl inf antibio       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9301002004inflation of the proximal tourniquet                                                                                                                                                                                                                                                                                 
G9302001003Prophylactic antibiotic not completely infused prior to the inflation of the    Norsn incomp inf antibio    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9302002004proximal tourniquet, reason not given                                                                                                                                                                                                                                                                                
G9303001003Operative report does not identify the prosthetic implant specifications        Norsn no pros info op rpt   00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9303002004including the prosthetic implant manufacturer, the brand name of the prosthetic                                                                                                                                                                                                                                      
G9303003004implant and the size of each prosthetic implant, reason not given                                                                                                                                                                                                                                                    
G9304001003Operative report identifies the prosthetic implant specifications including the Pros info op rpt            00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9304002004prosthetic implant manufacturer, the brand name of the prosthetic implant and                                                                                                                                                                                                                                        
G9304003004the size of each prosthetic implant                                                                                                                                                                                                                                                                                  
G9305001003Intervention for presence of leak of endoluminal contents through an            No interv req for leak      00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9305002004anastomosis not required                                                                                                                                                                                                                                                                                             
G9306001003Intervention for presence of leak of endoluminal contents through an            Interv req for leak         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9306002004anastomosis required                                                                                                                                                                                                                                                                                                 
G9307001003No return to the operating room for a surgical procedure, for complications of  No ret for surg w in 30d    00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9307002004the principal operative procedure, within 30 days of the principal operative                                                                                                                                                                                                                                         
G9307003004procedure                                                                                                                                                                                                                                                                                                            
G9308001003Unplanned return to the operating room for a surgical procedure, for            Unpl ret or w/compl w/in 30d00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9308002004complications of the principal operative procedure, within 30 days of the                                                                                                                                                                                                                                            
G9308003004principal operative procedure                                                                                                                                                                                                                                                                                        
G9309001003No unplanned hospital readmission within 30 days of principal procedure         No unplnd hosp readm in 30d 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9310001003Unplanned hospital readmission within 30 days of principal procedure            Unplnd hosp readm in 30d    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9311001003No surgical site infection                                                      No surg site infection      00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9312001003Surgical site infection                                                         Surgical site infection     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9313001003Amoxicillin, with or without clavulanate, not prescribed as first line          Amoxic not presc as 1st line00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9313002004antibiotic at the time of diagnosis for documented reason                                                                                                                                                                                                                                                            
G9314001003Amoxicillin, with or without clavulanate, not prescribed as first line          Norsn not first line amox   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9314002004antibiotic at the time of diagnosis, reason not given                                                                                                                                                                                                                                                                
G9315001003Documentation amoxicillin, with or without clavulanate, prescribed as a first   Doc first line amox         00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9315002004line antibiotic at the time of diagnosis                                                                                                                                                                                                                                                                             
G9316001003Documentation of patient-specific risk assessment with a risk calculator based  Doc comm risk calc          00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9316002004on multi-institutional clinical data, the specific risk calculator used, and                                                                                                                                                                                                                                         
G9316003004communication of risk assessment from risk calculator with the patient or family                                                                                                                                                                                                                                     
G9317001003Documentation of patient-specific risk assessment with a risk calculator based  No doc comm risk calc       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9317002004on multi-institutional clinical data, the specific risk calculator used, and                                                                                                                                                                                                                                         
G9317003004communication of risk assessment from risk calculator with the patient or                                                                                                                                                                                                                                            
G9317004004family not completed                                                                                                                                                                                                                                                                                                 
G9318001003Imaging study named according to standardized nomenclature                      Image std nomenclature      00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9319001003Imaging study not named according to standardized nomenclature, reason not givenImage not std nomenclature  00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9320001003Documentation of medical reason(s) for not naming ct studies according to a     Medrsn no std nomenclature  00      9                                                                                                     C                          M5B 1      0201401012016010120151231N                           
G9320002004standardized nomenclature provided (eg, ct studies performed for radiation                                                                                                                                                                                                                                           
G9320003004treatment planning or image-guided radiation treatment delivery)                                                                                                                                                                                                                                                     
G9321001003Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial  Doc count of ct in 12mo     00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9321002004perfusion) studies documented in the 12-month period prior to the current study                                                                                                                                                                                                                                      
G9322001003Count of previous ct and cardiac nuclear medicine (myocardial perfusion)        No doc count of ct in 12mo  00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9322002004studies not documented in the 12-month period prior to the current study,                                                                                                                                                                                                                                            
G9322003004reason not given                                                                                                                                                                                                                                                                                                     
G9323001003Documentation of medical reason(s) for not counting previous ct and cardiac     Mdrsn no doc cnt of ct      00      9                                                                                                     C                          M5B 1      0201401012016010120151231N                           
G9323002004nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for                                                                                                                                                                                                                                        
G9323003004radiation treatment planning or image-guided radiation treatment delivery)                                                                                                                                                                                                                                           
G9324001003All necessary data elements not included, reason not given                      Not all data norsn          00      9                                                                                                     C                          M5B 1      0201401012017010120161231N                           
G9325001003Ct studies not reported to a radiation dose index registry due to medical       Medrsn no ct rpt to reg     00      9                                                                                                     C                          M5B 1      0201401012016010120151231N                           
G9325002004reasons (eg, ct studies performed for radiation treatment planning or                                                                                                                                                                                                                                                
G9325003004image-guided radiation treatment delivery)                                                                                                                                                                                                                                                                           
G9326001003Ct studies performed not reported to a radiation dose index registry that is    Ct done no rad ds index, nrg00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9326002004capable of collecting at a minimum all necessary data elements, reason not given                                                                                                                                                                                                                                     
G9327001003Ct studies performed reported to a radiation dose index registry that is        Ct done rad ds index        00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9327002004capable of collecting at a minimum all necessary data elements                                                                                                                                                                                                                                                       
G9328001003Dicom format image data availability not documented in final report due to      Medrsn no dicom format doc  00      9                                                                                                     C                          M5B 1      0201401012016010120151231N                           
G9328002004medical reasons (eg, ct studies performed for radiation treatment planning or                                                                                                                                                                                                                                        
G9328003004image-guided radiation treatment delivery)                                                                                                                                                                                                                                                                           
G9329001003Dicom format image data available to non-affiliated external healthcare         Norsn no dicom format doc   00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9329002004facilities or entities on a secure, media free, reciprocally searchable basis                                                                                                                                                                                                                                        
G9329003004with patient authorization for at least a 12-month period after the study not                                                                                                                                                                                                                                        
G9329004004documented in final report, reason not given                                                                                                                                                                                                                                                                         
G9340001003Final report documented that dicom format image data available to               Dicom format doc on rpt     00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9340002004non-affiliated external healthcare facilities or entities on a secure, media                                                                                                                                                                                                                                         
G9340003004free, reciprocally searchable basis with patient authorization for at least a                                                                                                                                                                                                                                        
G934000400412-month period after the study                                                                                                                                                                                                                                                                                      
G9341001003Search conducted for prior patient ct studies completed at non-affiliated       Srch for ct w in 12 mos     00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9341002004external healthcare facilities or entities within the past 12-months and are                                                                                                                                                                                                                                         
G9341003004available through a secure, authorized, media-free, shared archive prior to an                                                                                                                                                                                                                                       
G9341004004imaging study being performed                                                                                                                                                                                                                                                                                        
G9342001003Search not conducted prior to an imaging study being performed for prior        No srch for ct in 12mo norsn00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9342002004patient ct studies completed at non-affiliated external healthcare facilities                                                                                                                                                                                                                                        
G9342003004or entities within the past 12-months and are available through a secure,                                                                                                                                                                                                                                            
G9342004004authorized, media-free, shared archive, reason not given                                                                                                                                                                                                                                                             
G9343001003Due to medical reasons, search not conducted for dicom format images for prior  Medrsn no dicom srch        00      9                                                                                                     C                          M5B 1      0201401012016010120151231N                           
G9343002004patient ct imaging studies completed at non-affiliated external healthcare                                                                                                                                                                                                                                           
G9343003004facilities or entities within the past 12 months that are available through a                                                                                                                                                                                                                                        
G9343004004secure, authorized, media-free, shared archive (e.g., ct studies performed for                                                                                                                                                                                                                                       
G9343005004radiation treatment planning or image-guided radiation treatment delivery)                                                                                                                                                                                                                                           
G9344001003Due to system reasons search not conducted for dicom format images for prior    Sysrsn no dicom srch        00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9344002004patient ct imaging studies completed at non-affiliated external healthcare                                                                                                                                                                                                                                           
G9344003004facilities or entities within the past 12 months that are available through a                                                                                                                                                                                                                                        
G9344004004secure, authorized, media-free, shared archive (e.g., non-affiliated external                                                                                                                                                                                                                                        
G9344005004healthcare facilities or entities does not have archival abilities through a                                                                                                                                                                                                                                         
G9344006004shared archival system)                                                                                                                                                                                                                                                                                              
G9345001003Follow-up recommendations documented according to recommended guidelines for    Follow up pulm nod          00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9345002004incidentally detected pulmonary nodules (e.g., follow-up ct imaging studies                                                                                                                                                                                                                                          
G9345003004needed or that no follow-up is needed) based at a minimum on nodule size and                                                                                                                                                                                                                                         
G9345004004patient risk factors                                                                                                                                                                                                                                                                                                 
G9346001003Follow-up recommendations not documented according to recommended guidelines    No follow up pulm nod       00      9                                                                                                     C                          M5B 1      0201401012016010120151231N                           
G9346002004for incidentally detected pulmonary nodules due to medical reasons (e.g.,                                                                                                                                                                                                                                            
G9346003004patients with known malignant disease, patients with unexplained fever, ct                                                                                                                                                                                                                                           
G9346004004studies performed for radiation treatment planning or image-guided radiation                                                                                                                                                                                                                                         
G9346005004treatment delivery)                                                                                                                                                                                                                                                                                                  
G9347001003Follow-up recommendations not documented according to recommended guidelines    No follow up pulm nod norsn 00      9                                                                                                     C                          M5B 1      02014010120150101        N                           
G9347002004for incidentally detected pulmonary nodules, reason not given                                                                                                                                                                                                                                                        
G9348001003Ct scan of the paranasal sinuses ordered at the time of diagnosis for           Doc rsn for ord ct scan     00      9                                                                                                     C                          M5B 1      02014010120180101        N                           
G9348002004documented reasons                                                                                                                                                                                                                                                                                                   
G9349001003Documentation of a ct scan of the paranasal sinuses ordered at the time of      Doc sinus ct 28d            00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9349002004diagnosis or received within 28 days after date of diagnosis                                                                                                                                                                                                                                                         
G9350001003Ct scan of the paranasal sinuses not ordered at the time of diagnosis or        No doc sinus ct 28d or dx   00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9350002004received within 28 days after date of diagnosis                                                                                                                                                                                                                                                                      
G9351001003More than one ct scan of the paranasal sinuses ordered or received within 90    Doc >1 sinus ct w 90d dx    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9351002004days after diagnosis                                                                                                                                                                                                                                                                                                 
G9352001003More than one ct scan of the paranasal sinuses ordered or received within 90    Not >1 sinus ct w 90d dx    00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9352002004days after the date of diagnosis, reason not given                                                                                                                                                                                                                                                                   
G9353001003More than one ct scan of the paranasal sinuses ordered or received within 90    Medrsn >1 sinus ct w 90d dx 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9353002004days after the date of diagnosis for documented reasons (eg, patients with                                                                                                                                                                                                                                           
G9353003004complications, second ct obtained prior to surgery, other medical reasons)                                                                                                                                                                                                                                           
G9354001003One ct scan or no ct scan of the paranasal sinuses ordered within 90 days after 1 or no ct sinus w/in 90d dx00      9                                                                                                     C                          M5B 1      02014010120160101        N                           
G9354002004the date of diagnosis                                                                                                                                                                                                                                                                                                
G9355001003Elective delivery or early induction not performed                              No early ind/delivery       00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9356001003Elective delivery or early induction performed                                  Early ind/delivery          00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9357001003Post-partum screenings, evaluations and education performed                     Pp eval/edu perf            00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9358001003Post-partum screenings, evaluations and education not performed                 Pp eval/edu not perf        00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9359001003Documentation of negative or managed positive tb screen with further evidence   Doc of neg or man pos tb scn00      9                                                                                                     C                          M5B 1      02014010120170101        N                           
G9359002004that tb is not active within one year of patient visit                                                                                                                                                                                                                                                               
G9360001003No documentation of negative or managed positive tb screen                      No doc of neg or man pos tb 00      9                                                                                                     C                          M5B 1      02014010120140101        N                           
G9361001003Medical indication for induction [documentation of reason(s) for elective       Doc rsn elect c-sec/induct  00      9                                                                                                     C                          Z2  1      02014010120170101        N                           
G9361002004delivery (c-section) or early induction (e.g., hemorrhage and placental                                                                                                                                                                                                                                              
G9361003004complications, hypertension, preeclampsia and eclampsia, rupture of                                                                                                                                                                                                                                                  
G9361004004membranes-premature or prolonged, maternal conditions complicating                                                                                                                                                                                                                                                   
G9361005004pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late                                                                                                                                                                                                                                           
G9361006004pregnancy, prior uterine surgery, or participation in clinical trial)]                                                                                                                                                                                                                                               
G9362001003Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb)     Mac or pnb w/o genanes >60m 00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9362002004without the use of general anesthesia during an applicable procedure 60 minutes                                                                                                                                                                                                                                      
G9362003004or longer, as documented in the anesthesia record                                                                                                                                                                                                                                                                    
G9363001003Duration of monitored anesthesia care (mac) or peripheral nerve block (pnb)     Mac or pnb w/o genanes <60m 00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9363002004without the use of general anesthesia during an applicable procedure or general                                                                                                                                                                                                                                      
G9363003004or neuraxial anesthesia less than 60 minutes, as documented in the anesthesia                                                                                                                                                                                                                                        
G9363004004record                                                                                                                                                                                                                                                                                                               
G9364001003Sinusitis caused by, or presumed to be caused by, bacterial infection           Sinus caus bac inx          00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9365001003One high-risk medication ordered                                                1high risk med ord          00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9366001003One high-risk medication not ordered                                            1high risk no ord           00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9367001003At least two orders for the same high-risk medication                           >= 2 same hi-rsk med ord    00      9                                                                                                     C                          Z2  1      02015010120180101        N                           
G9368001003At least two orders for the same high-risk medications not ordered              >= 2 same hi-rsk med not ord00      9                                                                                                     C                          Z2  1      02015010120180101        N                           
G9369001003Individual filled at least two prescriptions for any antipsychotic medication   Fill 2 rx antipsych         00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9369002004and had a pdc of 0.8 or greater                                                                                                                                                                                                                                                                                      
G9370001003Individual who did not fill at least two prescriptions for any antipsychotic    Not fill 2 rx antipsych     00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9370002004medication or did not have a pdc of 0.8 or greater                                                                                                                                                                                                                                                                   
G9376001003Patient continued to have the retina attached at the 6 months follow up visit   Contd ret attach at 6mth f/u00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9376002004(+/- 1 month) following only one surgery                                                                                                                                                                                                                                                                             
G9377001003Patient did not have the retina attached after 6 months following only one      No ret attach after 6mt     00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9377002004surgery                                                                                                                                                                                                                                                                                                              
G9378001003Patient continued to have the retina attached at the 6 months follow up visit   Contd ret attach f/u vis    00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9378002004(+/- 1 month)                                                                                                                                                                                                                                                                                                        
G9379001003Patient did not achieve flat retinas six months post surgery                    No acheive flat ret 6mth    00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9380001003Patient offered assistance with end of life issues during the measurement periodOff assis eol iss           00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9381001003Documentation of medical reason(s) for not offering assistance with end of life Doc med reas no offer eol   00      9                                                                                                     C                          Z2  1      0201501012018010120171231N                           
G9381002004issues (e.g., patient in hospice care, patient in terminal phase) during the                                                                                                                                                                                                                                         
G9381003004measurement period                                                                                                                                                                                                                                                                                                   
G9382001003Patient not offered assistance with end of life issues during the measurement   No off assis eol            00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9382002004period                                                                                                                                                                                                                                                                                                               
G9383001003Patient received screening for hcv infection within the 12 month reporting      Recd scrn hcv infec         00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9383002004period                                                                                                                                                                                                                                                                                                               
G9384001003Documentation of medical reason(s) for not receiving annual screening for hcv   Doc med rsn no hcv scrn     00      9                                                                                                     C                          Z2  1      02015010120180101        N                           
G9384002004infection (e.g., decompensated cirrhosis indicating advanced disease [i.e.,                                                                                                                                                                                                                                          
G9384003004ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular                                                                                                                                                                                                                                       
G9384004004carcinoma, waitlist for organ transplant, limited life expectancy, other                                                                                                                                                                                                                                             
G9384005004medical reasons)                                                                                                                                                                                                                                                                                                     
G9385001003Documentation of patient reason(s) for not receiving annual screening for hcv   Doc pt reas not rec hcv srn 00      9                                                                                                     C                          Z2  1      02015010120160101        N                           
G9385002004infection (e.g., patient declined, other patient reasons)                                                                                                                                                                                                                                                            
G9386001003Screening for hcv infection not received within the 12 month reporting period,  Scrn hcv infec not recd     00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9386002004reason not given                                                                                                                                                                                                                                                                                                     
G9389001003Unplanned rupture of the posterior capsule requiring vitrectomy during cataract Unpln rup post cap          00      9                                                                                                     C                          Z2  1      02015010120160101        N                           
G9389002004surgery                                                                                                                                                                                                                                                                                                              
G9390001003No unplanned rupture of the posterior capsule requiring vitrectomy during       No unpln rup post cap       00      9                                                                                                     C                          Z2  1      02015010120160101        N                           
G9390002004cataract surgery                                                                                                                                                                                                                                                                                                     
G9391001003Patient achieves refraction +-1 d for the eye that underwent cataract surgery,  Achv refrac +1d             00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9391002004measured at the one month follow up visit                                                                                                                                                                                                                                                                            
G9392001003Patient does not achieve refraction +-1 d for the eye that underwent cataract   Not achv refrac +1d         00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9392002004surgery, measured at the one month follow up visit                                                                                                                                                                                                                                                                   
G9393001003Patient with an initial phq-9 score greater than nine who achieves remission at Ini phq9 >9 remiss <5       00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9393002004twelve months as demonstrated by a twelve month (+/- 30 days) phq-9 score of                                                                                                                                                                                                                                         
G9393003004less than five                                                                                                                                                                                                                                                                                                       
G9394001003Patient who had a diagnosis of bipolar disorder or personality disorder, death, Dx bipol, death, nhres, hosp00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9394002004permanent nursing home resident or receiving hospice or palliative care any                                                                                                                                                                                                                                          
G9394003004time during the measurement or assessment period                                                                                                                                                                                                                                                                     
G9395001003Patient with an initial phq-9 score greater than nine who did not achieve       Ini phq9 >9 no remiss >=5   00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9395002004remission at twelve months as demonstrated by a twelve month (+/- 30 days)                                                                                                                                                                                                                                           
G9395003004phq-9 score greater than or equal to five                                                                                                                                                                                                                                                                            
G9396001003Patient with an initial phq-9 score greater than nine who was not assessed for  Ini phq9 >9 not assess      00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9396002004remission at twelve months (+/- 30 days)                                                                                                                                                                                                                                                                             
G9399001003Documentation in the patient record of a discussion between the                 Doc disc tx choices         00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9399002004physician/clinician and the patient that includes all of the following:                                                                                                                                                                                                                                              
G9399003004treatment choices appropriate to genotype, risks and benefits, evidence of                                                                                                                                                                                                                                           
G9399004004effectiveness, and patient preferences toward the outcome of the treatment                                                                                                                                                                                                                                           
G9400001003Documentation of medical or patient reason(s) for not discussing treatment      Doc reas no disc tx opt     00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9400002004options; medical reasons: patient is not a candidate for treatment due to                                                                                                                                                                                                                                            
G9400003004advanced physical or mental health comorbidity (including active substance                                                                                                                                                                                                                                           
G9400004004use); currently receiving antiviral treatment; successful antiviral treatment                                                                                                                                                                                                                                        
G9400005004(with sustained virologic response) prior to reporting period; other documented                                                                                                                                                                                                                                      
G9400006004medical reasons; patient reasons: patient unable or unwilling to participate in                                                                                                                                                                                                                                      
G9400007004the discussion or other patient reasons                                                                                                                                                                                                                                                                              
G9401001003No documentation of a discussion in the patient record of a discussion between  No disc tx choices          00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9401002004the physician or other qualfied healthcare professional and the patient that                                                                                                                                                                                                                                         
G9401003004includes all of the following: treatment choices appropriate to genotype, risks                                                                                                                                                                                                                                      
G9401004004and benefits, evidence of effectiveness, and patient preferences toward                                                                                                                                                                                                                                              
G9401005004treatment                                                                                                                                                                                                                                                                                                            
G9402001003Patient received follow-up on the date of discharge or within 30 days after     Recd f/u w/in 30d disch     00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9402002004discharge                                                                                                                                                                                                                                                                                                            
G9403001003Clinician documented reason patient was not able to complete 30 day follow-up   Doc reas no 30 day f/u      00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9403002004from acute inpatient setting discharge (e.g., patient death prior to follow-up                                                                                                                                                                                                                                       
G9403003004visit, patient non-compliant for visit follow-up)                                                                                                                                                                                                                                                                    
G9404001003Patient did not receive follow-up on the date of discharge or within 30 days    No 30 day f/u               00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9404002004after discharge                                                                                                                                                                                                                                                                                                      
G9405001003Patient received follow-up within 7 days from discharge                         Recd f/u w/in 7d disch      00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9406001003Clinician documented reason patient was not able to complete 7 day follow-up    Doc reas no 7d f/u          00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9406002004from acute inpatient setting discharge (i.e patient death prior to follow-up                                                                                                                                                                                                                                         
G9406003004visit, patient non-compliance for visit follow-up)                                                                                                                                                                                                                                                                   
G9407001003Patient did not receive follow-up on or within 7 days after discharge           No 7d f/u                   00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9408001003Patients with cardiac tamponade and/or pericardiocentesis occurring within 30   Card tamp w/in 30d          00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9408002004days                                                                                                                                                                                                                                                                                                                 
G9409001003Patients without cardiac tamponade and/or pericardiocentesis occurring within   No card tamp e/in 30d       00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G940900200430 days                                                                                                                                                                                                                                                                                                              
G9410001003Patient admitted within 180 days, status post cied implantation, replacement,   Admit w/in 180d req remov   00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9410002004or revision with an infection requiring device removal or surgical revision                                                                                                                                                                                                                                          
G9411001003Patient not admitted within 180 days, status post cied implantation,            No admit w/in 180d req remov00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9411002004replacement, or revision with an infection requiring device removal or surgical                                                                                                                                                                                                                                      
G9411003004revision                                                                                                                                                                                                                                                                                                             
G9412001003Patient admitted within 180 days, status post cied implantation, replacement,   Admit w/in 180d req surg rev00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9412002004or revision with an infection requiring device removal or surgical revision                                                                                                                                                                                                                                          
G9413001003Patient not admitted within 180 days, status post cied implantation,            No admit req surg rev       00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9413002004replacement, or revision with an infection requiring device removal or surgical                                                                                                                                                                                                                                      
G9413003004revision                                                                                                                                                                                                                                                                                                             
G9414001003Patient had one dose of meningococcal vaccine on or between the patient's 11th  1dose menig vac btwn 11 & 1300      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9414002004and 13th birthdays                                                                                                                                                                                                                                                                                                   
G9415001003Patient did not have one dose of meningococcal vaccine on or between the        No 1dose meni vac btwn 11&1300      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9415002004patient's 11th and 13th birthdays                                                                                                                                                                                                                                                                                    
G9416001003Patient had one tetanus, diphtheria toxoids and acellular pertussis vaccine     Pt 1 tdap betw 10-13 yrs    00      9                                                                                                     C                          Z2  1      02015010120170101        N                           
G9416002004(tdap) on or between the patient's 10th and 13th birthdays                                                                                                                                                                                                                                                           
G9417001003Patient did not have one tetanus, diphtheria toxoids and acellular pertussis    Pt not 1 tdap betw 10-13 yrs00      9                                                                                                     C                          Z2  1      02015010120170101        N                           
G9417002004vaccine (tdap) on or between the patient's 10th and 13th birthdays                                                                                                                                                                                                                                                   
G9418001003Primary non-small cell lung cancer biopsy and cytology specimen report          Lungcx bx rpt docs class    00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9418002004documents classification into specific histologic type or classified as                                                                                                                                                                                                                                              
G9418003004nsclc-nos with an explanation                                                                                                                                                                                                                                                                                        
G9419001003Documentation of medical reason(s) for not including the histological type or   Med reas not incl histo type00      9                                                                                                     C                          Z2  1      02015010120160101        N                           
G9419002004nsclc-nos classification with an explanation (e.g., biopsy taken for other                                                                                                                                                                                                                                           
G9419003004purposes in a patient with a history of primary non-small cell lung cancer or                                                                                                                                                                                                                                        
G9419004004other documented medical reasons)                                                                                                                                                                                                                                                                                    
G9420001003Specimen site other than anatomic location of lung or is not classified as      Spec site no lung           00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9420002004primary non-small cell lung cancer                                                                                                                                                                                                                                                                                   
G9421001003Primary non-small cell lung cancer biopsy and cytology specimen report does not Lung cx bx rpt no doc class 00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9421002004document classification into specific histologic type or classified as                                                                                                                                                                                                                                               
G9421003004nsclc-nos with an explanation                                                                                                                                                                                                                                                                                        
G9422001003Primary lung carcinoma resection report documents pt category, pn category and  Rpt doc class histo type    00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9422002004for non-small cell lung cancer, histologic type (squamous cell carcinoma,                                                                                                                                                                                                                                            
G9422003004adenocarcinoma and not nsclc-nos)                                                                                                                                                                                                                                                                                    
G9423001003Documentation of medical reason for not including pt category, pn category and  Med reas rpt no histo type  00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9423002004histologic type [for patient with appropriate exclusion criteria (e.g.,                                                                                                                                                                                                                                              
G9423003004metastatic disease, benign tumors, malignant tumors other than carcinomas,                                                                                                                                                                                                                                           
G9423004004inadequate surgical specimens)]                                                                                                                                                                                                                                                                                      
G9424001003Specimen site other than anatomic location of lung, or classified as nsclc-nos  Site no lung or lung cx     00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9425001003Primary lung carcinoma resection report does not document pt category, pn       Spec rpt no doc class histo 00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9425002004category and for non-small cell lung cancer, histologic type (squamous cell                                                                                                                                                                                                                                          
G9425003004carcinoma, adenocarcinoma)                                                                                                                                                                                                                                                                                           
G9426001003Improvement in median time from ed arrival to initial ed oral or parenteral     Impr med time edarr pain med00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9426002004pain medication administration performed for ed admitted patients                                                                                                                                                                                                                                                    
G9427001003Improvement in median time from ed arrival to initial ed oral or parenteral     No impro med time pain med  00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9427002004pain medication administration not performed for ed admitted patients                                                                                                                                                                                                                                                
G9428001003Pathology report includes the pt category and a statement on thickness,         Patho rpt incl pt ctg       00      9                                                                                                     C                          Z2  1      02015010120190101        C                           
G9428002004ulceration and mitotic rate                                                                                                                                                                                                                                                                                          
G9429001003Documentation of medical reason(s) for not including pt category and a          Doc med rsn no pt cat       00      9                                                                                                     C                          Z2  1      02015010120190101        C                           
G9429002004statement on thickness,  ulceration and mitotic rate (e.g., negative skin                                                                                                                                                                                                                                            
G9429003004biopsies in a patient with a history of melanoma or other documented medical                                                                                                                                                                                                                                         
G9429004004reasons)                                                                                                                                                                                                                                                                                                             
G9430001003Specimen site other than anatomic cutaneous location                            Spec site no cutaneous      00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9431001003Pathology report does not include the pt category and a statement on thickness, Patho rpt no pt ctg         00      9                                                                                                     C                          Z2  1      02015010120190101        C                           
G9431002004ulceration and mitotic rate                                                                                                                                                                                                                                                                                          
G9432001003Asthma well-controlled based on the act, c-act, acq, or ataq score and results  Asth controlled             00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9432002004documented                                                                                                                                                                                                                                                                                                           
G9433001003Death, permanent nursing home resident or receiving hospice or palliative care  Death, nhres, hospice       00      9                                                                                                     C                          Z2  1      0201501012016010120151231N                           
G9433002004any time during the measurement period                                                                                                                                                                                                                                                                               
G9434001003Asthma not well-controlled based on the act, c-act, acq, or ataq score, or      Asth not controlled         00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9434002004specified asthma control tool not used, reason not given                                                                                                                                                                                                                                                             
G9435001003Aspirin prescribed at discharge                                                 Asp presc disch             00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9436001003Aspirin not prescribed for documented reasons (e.g., allergy, medical           Asp not presc doc reas      00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9436002004intolerance, history of bleed)                                                                                                                                                                                                                                                                                       
G9437001003Aspirin not prescribed at discharge                                             Asp not presc disch         00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9438001003P2y inhibitor prescribed at discharge                                           P2y inhib presc             00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9439001003P2y inhibitor not prescribed for documented reasons (e.g., allergy, medical     P2y inhib not presc doc reas00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9439002004intolerance, history of bleed)                                                                                                                                                                                                                                                                                       
G9440001003P2y inhibitor not prescribed at discharge                                       P2y inhib not presc         00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9441001003Statin prescribed at discharge                                                  Statin presc disch          00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9442001003Statin not prescribed for documented reasons (e.g., allergy, medical            Statin not presc doc reas   00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9442002004intolerance)                                                                                                                                                                                                                                                                                                         
G9443001003Statin not prescribed at discharge                                              Statin not presc disch      00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9448001003Patients who were born in the years 1945?1965                                   Born 1945-1965              00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9449001003History of receiving blood transfusions prior to 1992                           Hx bld transf b/f 1992      00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9450001003History of injection drug use                                                   Hx injec drug use           00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9451001003Patient received one-time screening for hcv infection                           1x scrn hcv infect          00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9452001003Documentation of medical reason(s) for not receiving one-time screening for hcv Doc med reas no scrn hcv    00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9452002004infection (e.g., decompensated cirrhosis indicating advanced disease [ie,                                                                                                                                                                                                                                            
G9452003004ascites, esophageal variceal bleeding, hepatic encephalopathy], hepatocellular                                                                                                                                                                                                                                       
G9452004004carcinoma, waitlist for organ transplant, limited life expectancy, other                                                                                                                                                                                                                                             
G9452005004medical reasons)                                                                                                                                                                                                                                                                                                     
G9453001003Documentation of patient reason(s) for not receiving one-time screening for hcv Pt reas no hcv infect       00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9453002004infection (e.g., patient declined, other patient reasons)                                                                                                                                                                                                                                                            
G9454001003One-time screening for hcv infection not received within 12-month reporting     No scr hcv inf 12 mth rp    00      9                                                                                                     C                          Z2  1      02015010120190101        C                           
G9454002004period and no documentation of prior screening for hcv infection, reason not                                                                                                                                                                                                                                         
G9454003004given                                                                                                                                                                                                                                                                                                                
G9455001003Patient underwent abdominal imaging with ultrasound, contrast enhanced ct or    Abd imag w/us, ct or mri    00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9455002004contrast mri for hcc                                                                                                                                                                                                                                                                                                 
G9456001003Documentation of medical or patient reason(s) for not ordering or performing    Doc med pt reas no hcc scrn 00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9456002004screening for hcc. medical reason: comorbid medical conditions with expected                                                                                                                                                                                                                                         
G9456003004survival < 5 years, hepatic decompensation and not a candidate for liver                                                                                                                                                                                                                                             
G9456004004transplantation, or other medical reasons; patient reasons: patient declined or                                                                                                                                                                                                                                      
G9456005004other patient reasons (e.g., cost of tests, time related to accessing testing                                                                                                                                                                                                                                        
G9456006004equipment)                                                                                                                                                                                                                                                                                                           
G9457001003Patient did not undergo abdominal imaging and did not have a documented reason  Pt no abd img no doc rsn    00      9                                                                                                     C                          Z2  1      02015010120190101        C                           
G9457002004for not undergoing abdominal imaging in the submission period                                                                                                                                                                                                                                                        
G9458001003Patient documented as tobacco user and received tobacco cessation intervention  Tob user recd cess interv   00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9458002004(must include at least one of the following: advice given to quit smoking or                                                                                                                                                                                                                                         
G9458003004tobacco use, counseling on the benefits of quitting smoking or tobacco use,                                                                                                                                                                                                                                          
G9458004004assistance with or referral to external smoking or tobacco cessation support                                                                                                                                                                                                                                         
G9458005004programs, or current enrollment in smoking or tobacco use cessation program) if                                                                                                                                                                                                                                      
G9458006004identified as a tobacco user                                                                                                                                                                                                                                                                                         
G9459001003Currently a tobacco non-user                                                    Tob non-user                00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9460001003Tobacco assessment or tobacco cessation intervention not performed, reason not  No tob assess or cess inter 00      9                                                                                                     C                          Z2  1      02015010120160101        N                           
G9460002004given                                                                                                                                                                                                                                                                                                                
G9463001003I intend to report the sinusitis measures group                                 Sinusitis intent            00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9464001003All quality actions for the applicable measures in the sinusitis measures group Sinusitis comp              00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9464002004have been performed for this patient                                                                                                                                                                                                                                                                                 
G9465001003I intend to report the acute otitis externa (aoe) measures group                Aoe intent                  00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9466001003All quality actions for the applicable measures in the aoe measures group have  Aoe comp                    00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9466002004been performed for this patient                                                                                                                                                                                                                                                                                      
G9467001003Patient who have received or are receiving corticosteroids greater than or      Recd cortico >=10mg/day >60d00      9                                                                                                     C                          Z2  1      0201501012017010120161231N                           
G9467002004equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days                                                                                                                                                                                                                                      
G9467003004or a single prescription equating to 600 mg prednisone or greater for all fills                                                                                                                                                                                                                                      
G9467004004within the last twelve months                                                                                                                                                                                                                                                                                        
G9468001003Patient not receiving corticosteroids greater than or equal to 10 mg/day of     No recd cortico>=10mg/d >60d00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9468002004prednisone equivalents for 60 or greater consecutive days or a single                                                                                                                                                                                                                                                
G9468003004prescription equating to 600 mg prednisone or greater for all fills                                                                                                                                                                                                                                                  
G9469001003Patients who have received or are receiving corticosteroids greater than or     Rec cortico>60d or 1rx 600mg00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9469002004equal to 10 mg/day of prednisone equivalents for 60 or greater consecutive days                                                                                                                                                                                                                                      
G9469003004or a single prescription equating to 600 mg prednisone or greater for all fills                                                                                                                                                                                                                                      
G9470001003Patients not receiving corticosteroids greater than or equal to 10 mg/day of    No rec cortico>60d 1rx 600mg00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9470002004prednisone equivalents for 60 or greater consecutive days or a single                                                                                                                                                                                                                                                
G9470003004prescription equating to 600 mg prednisone or greater for all fills                                                                                                                                                                                                                                                  
G9471001003Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not     W/in 2yr dxa not order      00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9471002004ordered or documented                                                                                                                                                                                                                                                                                                
G9472001003Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) not     No dxa no med hx no rv sx   00      9                                                                                                     C                          Z2  1      02015010120150101        N                           
G9472002004ordered and documented, no review of systems and no medication history or                                                                                                                                                                                                                                            
G9472003004pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed                                                                                                                                                                                                                                     
G9473001003Services performed by chaplain in the hospice setting, each 15 minutes          Chap services at hospice    00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9474001003Services performed by dietary counselor in the hospice setting, each 15 minutes Diet counsel at hospice     00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9475001003Services performed by other counselor in the hospice setting, each 15 minutes   Other counselor at hospice  00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9476001003Services performed by volunteer in the hospice setting, each 15 minutes         Volun service at hospice    00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9477001003Services performed by care coordinator in the hospice setting, each 15 minutes  Care coord at hospice       00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9478001003Services performed by other qualified therapist in the hospice setting, each 15 Othe therapist at hospice   00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9478002004minutes                                                                                                                                                                                                                                                                                                              
G9479001003Services performed by qualified pharmacist in the hospice setting, each 15      Pharmacist at hospice       00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9479002004minutes                                                                                                                                                                                                                                                                                                              
G9480001003Admission to medicare care choice model program (mccm)                          Admission to mccm           00      9                                                                                                     C                          M5D 1      02016010120160101        N                           
G9481001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 10mins    00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9481002004only in a medicare-approved cms innovation center demonstration project, which                                                                                                                                                                                                                                       
G9481003004requires these 3 key components: a problem focused history;  a problem focused                                                                                                                                                                                                                                       
G9481004004examination; and straightforward medical decision making, furnished in real                                                                                                                                                                                                                                          
G9481005004time using interactive audio and video technology.  counseling and coordination                                                                                                                                                                                                                                      
G9481006004of care with other physicians, other qualified health care professionals or                                                                                                                                                                                                                                          
G9481007004agencies are provided consistent with the nature of the problem(s) and the                                                                                                                                                                                                                                           
G9481008004needs of the patient or the family or both. usually, the presenting problem(s)                                                                                                                                                                                                                                       
G9481009004are self limited or minor.  typically, 10 minutes are spent with the patient or                                                                                                                                                                                                                                      
G9481010004family or both via real time, audio and video intercommunications technology                                                                                                                                                                                                                                         
G9482001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 20mins    00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9482002004only in a medicare-approved cms innovation center demonstration project, which                                                                                                                                                                                                                                       
G9482003004requires these 3 key components: an expanded problem focused history; an                                                                                                                                                                                                                                             
G9482004004expanded problem focused examination;  straightforward medical decision making,                                                                                                                                                                                                                                      
G9482005004furnished in real time using interactive audio and video technology.                                                                                                                                                                                                                                                 
G9482006004counseling and coordination of care with other physicians, other qualified                                                                                                                                                                                                                                           
G9482007004health care professionals or agencies are provided consistent with the nature                                                                                                                                                                                                                                        
G9482008004of the problem(s) and the needs of the patient or the family or both.  usually,                                                                                                                                                                                                                                      
G9482009004the presenting problem(s) are of low to moderate severity.  typically, 20                                                                                                                                                                                                                                            
G9482010004minutes are spent with the patient or family or both via real time, audio and                                                                                                                                                                                                                                        
G9482011004video intercommunications technology                                                                                                                                                                                                                                                                                 
G9483001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 30mins    00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9483002004only in a medicare-approved cms innovation center demonstration project, which                                                                                                                                                                                                                                       
G9483003004requires these 3 key components: a detailed history; a detailed examination;                                                                                                                                                                                                                                         
G9483004004medical decision making of low complexity, furnished in real time using                                                                                                                                                                                                                                              
G9483005004interactive audio and video technology.  counseling and coordination of care                                                                                                                                                                                                                                         
G9483006004with other physicians, other qualified health care professionals or agencies                                                                                                                                                                                                                                         
G9483007004are provided consistent with the nature of the problem(s) and the needs of the                                                                                                                                                                                                                                       
G9483008004patient or the family or both.  usually, the presenting problem(s) are of                                                                                                                                                                                                                                            
G9483009004moderate severity.  typically, 30 minutes are spent with the patient or family                                                                                                                                                                                                                                       
G9483010004or both via real time, audio and video intercommunications technology                                                                                                                                                                                                                                                
G9484001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 45mins    00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9484002004only in a medicare-approved cms innovation center demonstration project, which                                                                                                                                                                                                                                       
G9484003004requires these 3 key components: a comprehensive history; a comprehensive                                                                                                                                                                                                                                            
G9484004004examination; medical decision making of moderate complexity, furnished in real                                                                                                                                                                                                                                       
G9484005004time using interactive audio and video technology. counseling and coordination                                                                                                                                                                                                                                       
G9484006004of care with other physicians, other qualified health care professionals or                                                                                                                                                                                                                                          
G9484007004agencies are provided consistent with the nature of the problem(s) and the                                                                                                                                                                                                                                           
G9484008004needs of the patient or the family or both.  usually, the presenting problem(s)                                                                                                                                                                                                                                      
G9484009004are of moderate to high severity.  typically, 45 minutes are spent with the                                                                                                                                                                                                                                          
G9484010004patient or family or both via real time, audio and video intercommunications                                                                                                                                                                                                                                         
G9484011004technology                                                                                                                                                                                                                                                                                                           
G9485001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 60mins    00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9485002004only in a medicare-approved cms innovation center demonstration project, which                                                                                                                                                                                                                                       
G9485003004requires these 3 key components: a comprehensive history; a comprehensive                                                                                                                                                                                                                                            
G9485004004examination; medical decision making of high complexity, furnished in real time                                                                                                                                                                                                                                      
G9485005004using interactive audio and video technology. counseling and coordination of                                                                                                                                                                                                                                         
G9485006004care with other physicians, other qualified health care professionals or                                                                                                                                                                                                                                             
G9485007004agencies are provided consistent with the nature of the problem(s) and the                                                                                                                                                                                                                                           
G9485008004needs of the patient or the family or both.  usually, the presenting problem(s)                                                                                                                                                                                                                                      
G9485009004are of moderate to high severity.  typically, 60 minutes are spent with the                                                                                                                                                                                                                                          
G9485010004patient or family or both via real time, audio and video intercommunications                                                                                                                                                                                                                                         
G9485011004technology                                                                                                                                                                                                                                                                                                           
G9486001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 10mins   00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9486002004patient for use only in a medicare-approved cms innovation center demonstration                                                                                                                                                                                                                                      
G9486003004project, which requires at least 2 of the following 3 key components: a problem                                                                                                                                                                                                                                      
G9486004004focused history; a problem focused examination; straightforward medical                                                                                                                                                                                                                                              
G9486005004decision making, furnished in real time using interactive audio and video                                                                                                                                                                                                                                            
G9486006004technology.  counseling and coordination of care with other physicians, other                                                                                                                                                                                                                                        
G9486007004qualified health care professionals or agencies are provided consistent with                                                                                                                                                                                                                                         
G9486008004the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                           
G9486009004both.  usually, the presenting problem(s) are self limited or minor.                                                                                                                                                                                                                                                 
G9486010004typically, 10 minutes are spent with the patient or family or both via real                                                                                                                                                                                                                                          
G9486011004time, audio and video intercommunications technology                                                                                                                                                                                                                                                                 
G9487001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 15mins   00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9487002004patient for use only in a medicare-approved cms innovation center demonstration                                                                                                                                                                                                                                      
G9487003004project, which requires at least 2 of the following 3 key components: an                                                                                                                                                                                                                                             
G9487004004expanded problem focused history; an expanded problem focused examination;                                                                                                                                                                                                                                           
G9487005004medical decision making of low complexity, furnished in real time using                                                                                                                                                                                                                                              
G9487006004interactive audio and video technology.  counseling and coordination of care                                                                                                                                                                                                                                         
G9487007004with other physicians, other qualified health care professionals or agencies                                                                                                                                                                                                                                         
G9487008004are provided consistent with the nature of the problem(s) and the needs of the                                                                                                                                                                                                                                       
G9487009004patient or the family or both.  usually, the presenting problem(s) are of low                                                                                                                                                                                                                                        
G9487010004to moderate severity.  typically, 15 minutes are spent with the patient or                                                                                                                                                                                                                                           
G9487011004family or both via real time, audio and video intercommunications technology                                                                                                                                                                                                                                         
G9488001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 25mins   00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9488002004patient for use only in a medicare-approved cms innovation center demonstration                                                                                                                                                                                                                                      
G9488003004project, which requires at least 2 of the following 3 key components: a                                                                                                                                                                                                                                              
G9488004004detailed history; a detailed examination; medical decision making of moderate                                                                                                                                                                                                                                        
G9488005004complexity, furnished in real time using interactive audio and video                                                                                                                                                                                                                                                 
G9488006004technology.  counseling and coordination of care with other physicians, other                                                                                                                                                                                                                                        
G9488007004qualified health care professionals or agencies are provided consistent with                                                                                                                                                                                                                                         
G9488008004the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                           
G9488009004both.  usually, the presenting problem(s) are of moderate to high severity.                                                                                                                                                                                                                                          
G9488010004typically, 25 minutes are spent with the patient or family or both via real                                                                                                                                                                                                                                          
G9488011004time, audio and video intercommunications technology                                                                                                                                                                                                                                                                 
G9489001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 40mins   00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9489002004patient for use only in a medicare-approved coms innovation center                                                                                                                                                                                                                                                   
G9489003004demonstration project, which requires at least 2 of the following 3 key                                                                                                                                                                                                                                              
G9489004004components: a comprehensive history; a comprehensive examination; medical                                                                                                                                                                                                                                            
G9489005004decision making of high complexity, furnished in real time using interactive                                                                                                                                                                                                                                         
G9489006004audio and video technology.  counseling and coordination of care with other                                                                                                                                                                                                                                          
G9489007004physicians, other qualified health care professionals or agencies are provided                                                                                                                                                                                                                                       
G9489008004consistent with the nature of the problem(s) and the needs of the patient or                                                                                                                                                                                                                                         
G9489009004the family or both.  usually, the presenting problem(s) are of moderate to high                                                                                                                                                                                                                                      
G9489010004severity.  typically, 40 minutes are spent with the patient or family or both                                                                                                                                                                                                                                        
G9489011004via real time, audio and video intercommunications technology                                                                                                                                                                                                                                                        
G9490001003Cms innovation center models, home visit for patient assessment performed by    Cmmi mod home visit         00      9                                                                                                     C                      0206Z2  1      02016040120180101        N                           
G9490002004clinical staff for an individual not considered homebound, including, but not                                                                                                                                                                                                                                        
G9490003004necessarily limited to patient assessment of clinical status, safety/fall                                                                                                                                                                                                                                            
G9490004004prevention, functional status/ambulation, medication reconciliation/management,                                                                                                                                                                                                                                      
G9490005004compliance with orders/plan of care, performance of activities of daily living,                                                                                                                                                                                                                                      
G9490006004and ensuring beneficiary connections to community and other services.  (for use                                                                                                                                                                                                                                      
G9490007004only in medicare-approved cms innovation center models); may not be billed for                                                                                                                                                                                                                                       
G9490008004a 30 day period covered by a transitional care management code                                                                                                                                                                                                                                                       
G9496001003Documentation of reason for not detecting adenoma(s) or other neoplasm. (e.g.,  Doc rsn no adeno/neopl detec00      9                                                                                                     C                          Z2  1      0201601012018010120171231N                           
G9496002004neoplasm detected is only diagnosed as traditional serrated adenoma, sessile                                                                                                                                                                                                                                         
G9496003004serrated polyp, or sessile serrated adenoma                                                                                                                                                                                                                                                                          
G9497001003Received instruction from the anesthesiologist or proxy prior to the day of     Rec inst no smoke day surg  00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9497002004surgery to abstain from smoking on the day of surgery                                                                                                                                                                                                                                                                
G9498001003Antibiotic regimen prescribed                                                   Abx reg prescribed          00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9499001003Patient did not start or is not receiving antiviral treatment for hepatitis c   No start/rec antvir tx hep c00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9499002004during the measurement period                                                                                                                                                                                                                                                                                        
G9500001003Radiation exposure indices, or exposure time and number of fluorographic images Rad expos ind/exp tm doc    00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9500002004in final report for procedures using fluoroscopy, documented                                                                                                                                                                                                                                                         
G9501001003Radiation exposure indices, or exposure time and number of fluorographic images Rad expos ind/exp tm no doc 00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9501002004not documented in final report for procedure using fluoroscopy, reason not given                                                                                                                                                                                                                                     
G9502001003Documentation of medical reason for not performing foot exam (i.e., patients    Med reas no perf foot exam  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9502002004who have had either a bilateral amputation above or below the knee, or both a                                                                                                                                                                                                                                        
G9502003004left and right amputation above or below the knee before or during the                                                                                                                                                                                                                                               
G9502004004measurement period)                                                                                                                                                                                                                                                                                                  
G9503001003Patient taking tamsulosin hydrochloride                                         Pt tk tams hcl              00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9504001003Documented reason for not assessing hepatitis b virus (hbv) status (e.g.,       Doc rsn hep b stat not asses00      9                                                                                                     C                          Z2  1      02016010120180101        N                           
G9504002004patient not initiating anti-tnf therapy, patient declined) prior to initiating                                                                                                                                                                                                                                       
G9504003004anti-tnf therapy                                                                                                                                                                                                                                                                                                     
G9505001003Antibiotic regimen prescribed within 10 days after onset of symptoms for        Abx pres w/in 10 dys of symp00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9505002004documented medical reason                                                                                                                                                                                                                                                                                            
G9506001003Biologic immune response modifier prescribed                                    Bio imm resp mod presc      00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9507001003Documentation that the patient is on a statin medication or has documentation   Doc reas on statin or contra00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9507002004of a valid contraindication or exception to statin medications;                                                                                                                                                                                                                                                      
G9507003004contraindications/exceptions that can be defined by diagnosis codes include                                                                                                                                                                                                                                          
G9507004004pregnancy during the measurement period, active liver disease, rhabdomyolysis,                                                                                                                                                                                                                                       
G9507005004end stage renal disease on dialysis and heart failure; provider documented                                                                                                                                                                                                                                           
G9507006004contraindications/exceptions include breastfeeding during the measurement                                                                                                                                                                                                                                            
G9507007004period, woman of child-bearing age not actively taking birth control, allergy                                                                                                                                                                                                                                        
G9507008004to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine,                                                                                                                                                                                                                                      
G9507009004gemfibrozil, and danazol) and intolerance (with supporting documentation of                                                                                                                                                                                                                                          
G9507010004trying a statin at least once within the last 5 years or diagnosis codes for                                                                                                                                                                                                                                         
G9507011004myostitis or toxic myopathy related to drugs)                                                                                                                                                                                                                                                                        
G9508001003Documentation that the patient is not on a statin medication                    Doc pt not on statin        00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9509001003Adult patients 18 years of age or older with major depression or dysthymia who  Adit mdd dys rem 12 mnths   00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9509002004reached remission at twelve months as demonstrated by a twelve month (+/-60                                                                                                                                                                                                                                          
G9509003004days) phq-9 or phq-9m score of less than 5                                                                                                                                                                                                                                                                           
G9510001003Remission at twelve months not demonstrated by a twelve month (+/-30 days)      Remis 12m not phq-9 score <500      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9510002004phq-9 score of less than five; either phq-9 score was not assessed or is                                                                                                                                                                                                                                             
G9510003004greater than or equal to 5                                                                                                                                                                                                                                                                                           
G9511001003Index event date phq-9 or phq-9m score greater than 9 documented during the     Idx evt dte phq>9 doc 12 mo 00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9511002004twelve month denominator identification period                                                                                                                                                                                                                                                                       
G9512001003Individual had a pdc of 0.8 or greater                                          Indiv pdc > 0.8             00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9513001003Individual did not have a pdc of 0.8 or greater                                 Indiv pdc not > 0.8         00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9514001003Patient required a return to the operating room within 90 days of surgery       Req ret or w/in 90d of surg 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9515001003Patient did not require a return to the operating room within 90 days of surgeryNo reas, no ret or w/in 90d 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9516001003Patient achieved an improvement in visual acuity, from their preoperative       Impr vis acuit w/in 90d     00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9516002004level, within 90 days of surgery                                                                                                                                                                                                                                                                                     
G9517001003Patient did not achieve an improvement in visual acuity, from their             No impr vis acuit w/in 90d  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9517002004preoperative level, within 90 days of surgery, reason not given                                                                                                                                                                                                                                                      
G9518001003Documentation of active injection drug use                                      Doc active inj drug use     00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9519001003Patient achieves final refraction (spherical equivalent) +/- 0.5 diopters of    Final ref +/- 0.5 w/in 90d  00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9519002004their planned refraction within 90 days of surgery                                                                                                                                                                                                                                                                   
G9520001003Patient does not achieve final refraction (spherical equivalent) +/- 0.5        Refract not +/- 0.5 w/in 90d00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9520002004diopters of their planned refraction within 90 days of surgery                                                                                                                                                                                                                                                       
G9521001003Total number of emergency department visits and inpatient hospitalizations less Er and ip hosp <2 in 12 mos 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9521002004than two in the past 12 months                                                                                                                                                                                                                                                                                       
G9522001003Total number of emergency department visits and inpatient hospitalizations      Er/ip hosp =/>2 in 12 mos   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9522002004equal to or greater than two in the past 12 months or patient not screened,                                                                                                                                                                                                                                          
G9522003004reason not given                                                                                                                                                                                                                                                                                                     
G9523001003Patient discontinued from hemodialysis or peritoneal dialysis                   D/c hemo or perit dialysis  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9524001003Patient was referred to hospice care                                            Refer to hospice            00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9525001003Documentation of patient reason(s) for not referring to hospice care (e.g.,     Doc pt reas no hospice refer00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9525002004patient declined, other patient reasons)                                                                                                                                                                                                                                                                             
G9526001003Patient was not referred to hospice care, reason not given                      No reason, no refer hospice 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9529001003Patient with minor blunt head trauma had an appropriate indication(s) for a     Minor blunt trauma w/head ct00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9529002004head ct                                                                                                                                                                                                                                                                                                              
G9530001003Patient presented with a minor blunt head trauma  and had a head ct ordered for Pt mbht hd ct ord ec prov   00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9530002004trauma by an emergency care provider                                                                                                                                                                                                                                                                                 
G9531001003Patient has documentation of ventricular shunt, brain tumor, multisystem        Pt doc                      00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9531002004trauma, pregnancy, or is currently taking an antiplatelet medication including:                                                                                                                                                                                                                                      
G9531003004abciximab, cangrelor, cilostazol, clopidogrel, eptifibatide, prasugrel,                                                                                                                                                                                                                                              
G9531004004ticlopidine, ticagrelor, tirofiban, or vorapaxar                                                                                                                                                                                                                                                                     
G9532001003Patient had a head ct for trauma ordered by someone other than an emergency     Pt hd ct ord                00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9532002004care provider  or was ordered for a reason other than trauma                                                                                                                                                                                                                                                         
G9533001003Patient with minor blunt head trauma did not have an appropriate indication(s)  Indic for head ct not valid 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9533002004for a head ct                                                                                                                                                                                                                                                                                                        
G9534001003Advanced brain imaging (cta, ct, mra or mri) was not ordered                    Adv brain image not ordered 00      9                                                                                                     C                          Z2  1      0201601012019010120181231D                           
G9535001003Patients with a normal neurological examination                                 Normal neuro exam           00      9                                                                                                     C                          Z2  1      0201601012019010120181231D                           
G9536001003Documentation of medical reason(s) for ordering an advanced brain imaging study Doc med reas adv brain image00      9                                                                                                     C                          Z2  1      0201601012019010120181231D                           
G9536002004(i.e., patient has an abnormal neurological examination; patient has the                                                                                                                                                                                                                                             
G9536003004coexistence of seizures, or both; recent onset of severe headache; change in                                                                                                                                                                                                                                         
G9536004004the type of headache; signs of increased intracranial pressure (e.g.,                                                                                                                                                                                                                                                
G9536005004papilledema, absent venous pulsations on funduscopic examination, altered                                                                                                                                                                                                                                            
G9536006004mental status, focal neurologic deficits, signs of meningeal irritation);                                                                                                                                                                                                                                            
G9536007004hiv-positive patients with a new type of headache; immunocompromised patient                                                                                                                                                                                                                                         
G9536008004with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or                                                                                                                                                                                                                                      
G9536009004anti-platelet therapy; very young patients with unexplained headache symptoms)                                                                                                                                                                                                                                       
G9537001003Documentation of system reason(s) for obtaining imaging of the head (ct or mri) Doc sysm rsn img hd         00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9537002004(i.e., needed as part of a clinical trial; other clinician ordered the study)                                                                                                                                                                                                                                        
G9538001003Advanced brain imaging (cta, ct, mra or mri) was ordered                        Adv brain image ordered     00      9                                                                                                     C                          Z2  1      0201601012019010120181231D                           
G9539001003Intent for potential removal at time of placement                               Intent pot remv time placemt00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9540001003Patient alive 3 months post procedure                                           Pt alive 3 mos post proc    00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9541001003Filter removed within 3 months of placement                                     Filter rem 3 mon plmt       00      9                                                                                                     C                          Z2  1      02016010120180101        N                           
G9542001003Documented re-assessment for the appropriateness of filter removal within 3     Doc reass appr remo filt 3ms00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9542002004months of placement                                                                                                                                                                                                                                                                                                  
G9543001003Documentation of at least two attempts to reach the patient to arrange a        Doc 2x re-assess filt remov 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9543002004clinical re-assessment for the appropriateness of filter removal within 3                                                                                                                                                                                                                                            
G9543003004months of placement                                                                                                                                                                                                                                                                                                  
G9544001003Patients that do not have the filter removed, documented re-assessment for the  No filt remov w/in 3mos plcm00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9544002004appropriateness of filter removal, or documentation of at least two attempts to                                                                                                                                                                                                                                      
G9544003004reach the patient to arrange a clinical re-assessment for the appropriateness                                                                                                                                                                                                                                        
G9544004004of filter removal within 3 months of placement                                                                                                                                                                                                                                                                       
G9547001003Incidental finding: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or    Incid finding liver/kid/adre00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9547002004adrenal lesion <= 1.0 cm                                                                                                                                                                                                                                                                                             
G9548001003Final reports for abdominal imaging studies with follow-up imaging recommended  Abd imag and followup rec   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9549001003Documentation of medical reason(s) that follow-up imaging is indicated (e.g.,   Doc med rsn for follow imag 00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9549002004patient has a known malignancy that can metastasize, other medical reason(s)                                                                                                                                                                                                                                         
G9549003004such as fever in an immunocompromised patient)                                                                                                                                                                                                                                                                       
G9550001003Final reports for abdominal imaging studies with follow-up imaging not          Abd imag and followup no rec00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9550002004recommended                                                                                                                                                                                                                                                                                                          
G9551001003Final reports for abdominal imaging studies without an incidentally found       Abd imag no les,kid/livr/adr00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9551002004lesion noted: liver lesion <= 0.5 cm, cystic kidney lesion < 1.0 cm or adrenal                                                                                                                                                                                                                                       
G9551003004lesion <= 1.0 cm noted or no lesion found                                                                                                                                                                                                                                                                            
G9552001003Incidental thyroid nodule < 1.0 cm noted in report                              Inc thyr node <1.0 in rpt   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9553001003Prior thyroid disease diagnosis                                                 Prior thyroid dise dx       00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9554001003Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the Ct/cta/mri/a chst foll rec  00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9554002004neck with follow-up imaging recommended                                                                                                                                                                                                                                                                              
G9555001003Documentation of medical reason(s) for recommending follow up imaging (e.g.,    Doc med rsn for follup image00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9555002004patient has multiple endocrine neoplasia, patient has cervical lymphadenopathy,                                                                                                                                                                                                                                      
G9555003004other medical reason(s))                                                                                                                                                                                                                                                                                             
G9556001003Final reports for ct, cta, mri or mra of the chest or neck or ultrasound of the Ct/cta/mri/a no follup imag 00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9556002004neck with follow-up imaging not recommended                                                                                                                                                                                                                                                                          
G9557001003Final reports for ct, cta, mri or mra studies of the chest or neck or           Ct/cta/mri/a no thyr <1.0cm 00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9557002004ultrasound of the neck without an incidentally found thyroid nodule < 1.0 cm                                                                                                                                                                                                                                         
G9557003004noted or no nodule found                                                                                                                                                                                                                                                                                             
G9558001003Patient treated with a beta-lactam antibiotic as definitive therapy             Tx beta-lactam abx therapy  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9559001003Documentation of medical reason(s) for not prescribing a beta-lactam antibiotic Doc med reas no abx therapy 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9559002004(e.g., allergy, intolerance to beta-lactam antibiotics)                                                                                                                                                                                                                                                              
G9560001003Patient not treated with a beta-lactam antibiotic as definitive therapy, reason No beta-lactam abx ther, rng00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9560002004not given                                                                                                                                                                                                                                                                                                            
G9561001003Patients prescribed opiates for longer than six weeks                           Presc opiates >6 wks        00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9562001003Patients who had a follow-up evaluation conducted at least every three months   Foll-up eval q3mo opiod tx  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9562002004during opioid therapy                                                                                                                                                                                                                                                                                                
G9563001003Patients who did not have a follow-up evaluation conducted at least every three No f/u eval q3mo opiod tx   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9563002004months during opioid therapy                                                                                                                                                                                                                                                                                         
G9572001003Index date phq-score greater than 9 documented during the twelve month          Phq-scr >9 doc in 12m time  00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9572002004denominator identification period                                                                                                                                                                                                                                                                                    
G9573001003Adult patients 18 years of age or older with major depression or dysthymia who  Adl pt md or dys rem 6 mon  00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9573002004did not reach remission at six months as demonstrated by a six month (+/-60                                                                                                                                                                                                                                          
G9573003004days) phq-9 or phq-9m score of less than five                                                                                                                                                                                                                                                                        
G9574001003Adult patients 18 years of age or older with major depression or dysthymia who  Adl pt md dys no rem 6 mon  00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9574002004did not reach remission at six months as demonstrated by a six month (+/-60                                                                                                                                                                                                                                          
G9574003004days) phq-9 or phq-9m score of less than five; either phq-9 or phq-9m score was                                                                                                                                                                                                                                      
G9574004004not assessed or is greater than or equal to five                                                                                                                                                                                                                                                                     
G9577001003Patients prescribed opiates for longer than six weeks                           Presc opiates >6 wks        00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9578001003Documentation of signed opioid treatment agreement at least once during opioid  Doc opioid tx 1x during ther00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9578002004therapy                                                                                                                                                                                                                                                                                                              
G9579001003No documentation of signed an opioid treatment agreement at least once during   No doc opioid tx 1x at ther 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9579002004opioid therapy                                                                                                                                                                                                                                                                                                       
G9580001003Door to puncture time of less than 2 hours                                      Door to punc time <2hrs     00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9581001003Door to puncture time of greater than 2 hours for reasons documented by         Md doc, door to punc tm >2hr00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9581002004clinician (e.g., patients who are transferred from one institution to another                                                                                                                                                                                                                                        
G9581003004with a known diagnosis of cva for endovascular stroke treatment; hospitalized                                                                                                                                                                                                                                        
G9581004004patients with newly diagnosed cva considered for endovascular stroke treatment)                                                                                                                                                                                                                                      
G9582001003Door to puncture time of greater than 2 hours, no reason given                  Door to punc time >2hr, nrg 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9583001003Patients prescribed opiates for longer than six weeks                           Presc opiates >6 wks        00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9584001003Patient evaluated for risk of misuse of opiates by using a brief validated      Eval opioid use instr/pt int00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9584002004instrument (e.g., opioid risk tool, soapp-r) or patient interviewed at least                                                                                                                                                                                                                                         
G9584003004once during opioid therapy                                                                                                                                                                                                                                                                                           
G9585001003Patient not evaluated for risk of misuse of opiates by using a brief validated  No eval opi use instr/intv  00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9585002004instrument (e.g., opioid risk tool, soapp-r) or patient not interviewed at                                                                                                                                                                                                                                           
G9585003004least once during opioid therapy                                                                                                                                                                                                                                                                                     
G9593001003Pediatric patient with minor blunt head trauma classified as low risk according Low pecarn ped head trauma  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9593002004to the pecarn prediction rules                                                                                                                                                                                                                                                                                       
G9594001003Patient presented with a minor blunt head trauma and had a head ct ordered for  Pt mbht hd ct ord ec prov   00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9594002004trauma by an emergency care provider                                                                                                                                                                                                                                                                                 
G9595001003Patient has documentation of ventricular shunt, brain tumor, coagulopathy,      Doc shnt/tum/coag/thrombocyt00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9595002004including thrombocytopenia                                                                                                                                                                                                                                                                                           
G9596001003Pediatric patient had a head ct for trauma ordered by someone other than an     Ped pt hd ct ord            00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9596002004emergency care provider or was ordered for a reason other than trauma                                                                                                                                                                                                                                                
G9597001003Pediatric patient with minor blunt head trauma not classified as low risk       No low pecarn ped head traum00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9597002004according to the pecarn prediction rules                                                                                                                                                                                                                                                                             
G9598001003Aortic aneurysm 5.5 - 5.9 cm maximum diameter on centerline formatted ct or     Aor ane 5.5-5.9 cm max diam 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9598002004minor diameter on axial formatted ct                                                                                                                                                                                                                                                                                 
G9599001003Aortic aneurysm 6.0 cm or greater maximum diameter on centerline formatted ct   Aor ane >=6.0 cm max diam   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9599002004or minor diameter on axial formatted ct                                                                                                                                                                                                                                                                              
G9600001003Symptomatic aaas that required urgent/emergent (non-elective) repair            Symp aaa urgent repair      00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9601001003Patient discharge to home no later than post-operative day #7                   Pt dchg home post op day 7  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9602001003Patient not discharged to home by post-operative day #7                         Pt no dchg home postop day 700      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9603001003Patient survey score improved from baseline following treatment                 Pt surv improv bsline tx    00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9604001003Patient survey results not available                                            Pt surv results not avail   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9605001003Patient survey score did not improve from baseline following treatment          Surv score no improv w/tx   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9606001003Intraoperative cystoscopy performed to evaluate for lower tract injury          Intraop cyst eval trac inj  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9607001003Documented medical reasons for not performing intraoperative cystoscopy (e.g.,  Doc med rsn not perf cystosc00      9                                                                                                     C                          Z2  1      02016010120180101        N                           
G9607002004urethral pathology precluding cystoscopy, any patient who has a congenital or                                                                                                                                                                                                                                        
G9607003004acquired absence of the urethra) or in the case of patient death                                                                                                                                                                                                                                                     
G9608001003Intraoperative cystoscopy not performed to evaluate for lower tract injury      Intraop cyst eval not done  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9609001003Documentation of an order for anti-platelet agents                              Doc order anti-plat         00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9610001003Documentation of medical reason(s) in the patient's record for not ordering     Doc md rsn no antipla       00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9610002004anti-platelet agents                                                                                                                                                                                                                                                                                                 
G9611001003Order for anti-platelet agents was not documented in the patient's record,      No doc order anti-plat rng  00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9611002004reason not given                                                                                                                                                                                                                                                                                                     
G9612001003Photodocumentation of two or more cecal landmarks to establish a complete       Phodoc 2 mr cec lndmk       00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9612002004examination                                                                                                                                                                                                                                                                                                          
G9613001003Documentation of post-surgical anatomy (e.g., right hemicolectomy, ileocecal    Doc post surg anatomy       00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9613002004resection, etc.)                                                                                                                                                                                                                                                                                                     
G9614001003Photodocumentation of less than two cecal landmarks (i.e., no cecal landmarks   Photodoc < 2 cec lndmk      00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9614002004or only one cecal landmark) to establish a complete examination                                                                                                                                                                                                                                                      
G9615001003Preoperative assessment documented                                              Pre-op asst doc             00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9616001003Documentation of reason(s) for not documenting a preoperative assessment (e.g., Doc rsn no preop assmt      00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9616002004patient with a gynecologic or other pelvic malignancy noted at the time of                                                                                                                                                                                                                                           
G9616003004surgery)                                                                                                                                                                                                                                                                                                             
G9617001003Preoperative assessment not documented, reason not given                        Pre-op asst not doc, rng    00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9618001003Documentation of screening for uterine malignancy or those that had an          Doc scr uter mal or us/samp 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9618002004ultrasound and/or endometrial sampling of any kind                                                                                                                                                                                                                                                                   
G9619001003Documentation of reason(s) for not screening for uterine malignancy (e.g.,      Doc rsn no scr uter malig   00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9619002004prior hysterectomy)                                                                                                                                                                                                                                                                                                  
G9620001003Patient not screened for uterine malignancy, or those that have not had an      No scr utr malig/us/samp rng00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9620002004ultrasound and/or endometrial sampling of any kind, reason not given                                                                                                                                                                                                                                                 
G9621001003Patient identified as an unhealthy alcohol user when screened for unhealthy     Scr unheal etoh w/counsel   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9621002004alcohol use using a systematic screening method and received brief counseling                                                                                                                                                                                                                                        
G9622001003Patient not identified as an unhealthy alcohol user when screened for unhealthy No unheal etoh user         00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9622002004alcohol use using a systematic screening method                                                                                                                                                                                                                                                                      
G9623001003Documentation of medical reason(s) for not screening for unhealthy alcohol use  Doc med rsn no scr etoh use 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9623002004(e.g., limited life expectancy, other medical reasons)                                                                                                                                                                                                                                                               
G9624001003Patient not screened for unhealthy alcohol use using a systematic screening     Pt not scrn or no counseling00      9                                                                                                     C                          Z2  1      02016010120180101        N                           
G9624002004method or patient did not receive brief counseling if identified as an                                                                                                                                                                                                                                               
G9624003004unhealthy alcohol user, reason not given                                                                                                                                                                                                                                                                             
G9625001003Patient sustained bladder injury at the time of surgery or discovered           Pt bl srg 30 day pst srg    00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9625002004subsequently up to 30 days post-surgery                                                                                                                                                                                                                                                                              
G9626001003Documented medical reason for not reporting bladder injury (e.g., gynecologic   Med rsn no rpt baldder inj  00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9626002004or other pelvic malignancy documented, concurrent surgery involving bladder                                                                                                                                                                                                                                          
G9626003004pathology, injury that occurs during urinary incontinence procedure, patient                                                                                                                                                                                                                                         
G9626004004death from non-medical causes not related to surgery, patient died during                                                                                                                                                                                                                                            
G9626005004procedure without evidence of bladder injury)                                                                                                                                                                                                                                                                        
G9627001003Patient did not sustain bladder injury at the time of surgery nor discovered    Pt no bl srg 30 day pst srg 00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9627002004subsequently up to 30n days post-surgery                                                                                                                                                                                                                                                                             
G9628001003Patient sustained bowel injury at the time of surgery or discovered             Pt bwli srg 30 day pst srg  00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9628002004subsequently up to 30 days  post-surgery                                                                                                                                                                                                                                                                             
G9629001003Documented medical reasons for not reporting bowel injury (e.g., gynecologic or Med rsn no rpt bowel inj    00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9629002004other pelvic malignancy documented, planned (e.g., not due to an unexpected                                                                                                                                                                                                                                          
G9629003004bowel injury) resection and/or re-anastomosis of bowel, or patient death from                                                                                                                                                                                                                                        
G9629004004non-medical causes not related to surgery, patient died during procedure                                                                                                                                                                                                                                             
G9629005004without evidence of bowel injury)                                                                                                                                                                                                                                                                                    
G9630001003Patient did not sustain a bowel injury at the time of surgery nor discovered    Pt no bwli srg 30 day srg   00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9630002004subsequently up to 30 days post-surgery                                                                                                                                                                                                                                                                              
G9631001003Patient sustained ureter injury at the time of surgery or discovered            Pt ui srg 30 day pst srg    00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9631002004subsequently up to 30 days post-surgery                                                                                                                                                                                                                                                                              
G9632001003Documented medical reasons for not reporting ureter injury (e.g., gynecologic   Med rsn for no rpt uret inj 00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9632002004or other pelvic malignancy documented, concurrent surgery involving bladder                                                                                                                                                                                                                                          
G9632003004pathology, injury that occurs during a urinary incontinence procedure, patient                                                                                                                                                                                                                                       
G9632004004death from non-medical causes not related to surgery, patient died during                                                                                                                                                                                                                                            
G9632005004procedure without evidence of ureter injury)                                                                                                                                                                                                                                                                         
G9633001003Patient did not sustain ureter injury at the time of surgery nor discovered     Pt no ui srg 30 day pst srg 00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9633002004subsequently up to 30 days post-surgery                                                                                                                                                                                                                                                                              
G9634001003Health-related quality of life assessed with tool during at least two visits    Qual life tool 2x same/impr 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9634002004and quality of life score remained the same or improved                                                                                                                                                                                                                                                              
G9635001003Health-related quality of life not assessed with tool for documented reason(s)  No doc rsn do qual life assm00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9635002004(e.g., patient has a cognitive or neuropsychiatric impairment that impairs                                                                                                                                                                                                                                           
G9635003004his/her ability to complete the hrqol survey, patient has the inability to read                                                                                                                                                                                                                                      
G9635004004and/or write in order to complete the hrqol questionnaire)                                                                                                                                                                                                                                                           
G9636001003Health-related quality of life not assessed with tool during at least two       No life asst 2x same/decr   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9636002004visits or quality of life score declined                                                                                                                                                                                                                                                                             
G9637001003Final reports with documentation of one or more dose reduction techniques       Doc >1 dose reduc tech      00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9637002004(e.g., automated exposure control, adjustment of the ma and/or kv according to                                                                                                                                                                                                                                       
G9637003004patient size, use of iterative reconstruction technique)                                                                                                                                                                                                                                                             
G9638001003Final reports without documentation of one or more dose reduction techniques    No doc >1 dose reduc tech   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9638002004(e.g., automated exposure control, adjustment of the ma and/or kv according to                                                                                                                                                                                                                                       
G9638003004patient size, use of iterative reconstruction technique)                                                                                                                                                                                                                                                             
G9639001003Major amputation or open surgical bypass not required within 48 hours of the    Amp no reqd in48h ieler proc00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9639002004index endovascular lower extremity revascularization procedure                                                                                                                                                                                                                                                       
G9640001003Documentation of planned hybrid or staged procedure                             Doc plan hybrid/stage proc  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9641001003Major amputation or open surgical bypass required within 48 hours of the index  Amp reqd w/in 48h ieler proc00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9641002004endovascular lower extremity revascularization procedure                                                                                                                                                                                                                                                             
G9642001003Current smokers (e.g., cigarette, cigar, pipe, e-cigarette or marijuana)        Current smoker              00      9                                                                                                     C                          Z2  1      02016010120170101        N                           
G9643001003Elective surgery                                                                Elective surgery            00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9644001003Patients who abstained from smoking prior to anesthesia on the day of surgery   No smok b/4 anes day of surg00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9644002004or procedure                                                                                                                                                                                                                                                                                                         
G9645001003Patients who did not abstain from smoking prior to anesthesia on the day of     Had smoke b/4 anes day surg 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9645002004surgery or procedure                                                                                                                                                                                                                                                                                                 
G9646001003Patients with 90 day mrs score of 0 to 2                                        Pt w/90d mrs 0-2            00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9647001003Patients in whom mrs score could not be obtained at 90 day follow-up            No mrs score in 90d followup00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9648001003Patients with 90 day mrs score greater than 2                                   Pt w/90d mrs >2             00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9649001003Psoriasis assessment tool documented meeting any one of the specified           Psor as doc spc bm          00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9649002004benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa),                                                                                                                                                                                                                                          
G9649003004psoriasis area and severity index (pasi) and/or dermatology life quality index)                                                                                                                                                                                                                                      
G9649004004(dlqi))                                                                                                                                                                                                                                                                                                              
G9650001003Documentation that the patient declined therapy change or has documented        Doc pt no ther chg or contra00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9650002004contraindications (e.g., experienced adverse effects or lack of efficacy with                                                                                                                                                                                                                                        
G9650003004all other therapy options) in order to achieve better disease control as                                                                                                                                                                                                                                             
G9650004004measured by pga, bsa, pasi, or dlqi                                                                                                                                                                                                                                                                                  
G9651001003Psoriasis assessment tool documented not meeting any one of the specified       Psor as doc no spc bm       00      9                                                                                                     C                          Z2  1      02016010120190101        C                           
G9651002004benchmarks (e.g., (pga; 5-point or 6-point scale), body surface area (bsa),                                                                                                                                                                                                                                          
G9651003004psoriasis area and severity index (pasi) and/or dermatology life quality index)                                                                                                                                                                                                                                      
G9651004004(dlqi)) or psoriasis assessment tool not documented                                                                                                                                                                                                                                                                  
G9652001003Patient has been treated with a systemic or biologic medication for psoriasis   Pt tx sys bio med psori 6mth00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9652002004for at least six months                                                                                                                                                                                                                                                                                              
G9653001003Patient has not been treated with a systemic or biologic medication for         Pt no tx sys bio rx 6 mths  00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9653002004psoriasis for at least six months                                                                                                                                                                                                                                                                                    
G9654001003Monitored anesthesia care (mac)                                                 Mon anesth care             00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9655001003A transfer of care protocol or handoff tool/checklist that includes the         Toc tool incl key elem      00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9655002004required key handoff elements is used                                                                                                                                                                                                                                                                                
G9656001003Patient transferred directly from anesthetizing location to pacu or other       Pt trans from anest to pacu 00      9                                                                                                     C                          Z2  1      02016010120180101        N                           
G9656002004non-icu location                                                                                                                                                                                                                                                                                                     
G9657001003Transfer of care during an anesthetic or to the intensive care unit             Toc dur aneth to icu        00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9658001003A transfer of care protocol or handoff tool/checklist that includes the         Toc tool incl elem not used 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9658002004required key handoff elements is not used                                                                                                                                                                                                                                                                            
G9659001003Patients greater than 85 years of age who did not have a history of colorectal  >85y no hx colo ca/rsn scope00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9659002004cancer or valid medical reason for the colonoscopy, including: iron deficiency                                                                                                                                                                                                                                       
G9659003004anemia, lower gastrointestinal bleeding, crohn's disease (i.e., regional                                                                                                                                                                                                                                             
G9659004004enteritis), familial adenomatous polyposis, lynch syndrome (i.e., hereditary                                                                                                                                                                                                                                         
G9659005004non-polyposis colorectal cancer), inflammatory bowel disease, ulcerative                                                                                                                                                                                                                                             
G9659006004colitis, abnormal finding of gastrointestinal tract, or changes in bowel habits                                                                                                                                                                                                                                      
G9660001003Documentation of medical reason(s) for a colonoscopy performed on a patient     Doc med rsn scope pt >85y   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9660002004greater than 85 years of age (e.g., last colonoscopy incomplete, last                                                                                                                                                                                                                                                
G9660003004colonoscopy had inadequate prep, iron deficiency anemia, lower gastrointestinal                                                                                                                                                                                                                                      
G9660004004bleeding, crohn's disease (i.e., regional enteritis), familial history of                                                                                                                                                                                                                                            
G9660005004adenomatous polyposis, lynch syndrome (i.e., hereditary non-polyposis                                                                                                                                                                                                                                                
G9660006004colorectal cancer), inflammatory bowel disease, ulcerative colitis, abnormal                                                                                                                                                                                                                                         
G9660007004finding of gastrointestinal tract, or changes in bowel habits)                                                                                                                                                                                                                                                       
G9661001003Patients greater than 85 years of age who received a routine colonoscopy for a  >85y scope othr rsn         00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9661002004reason other than the following: an assessment of signs/symptoms of gi tract                                                                                                                                                                                                                                         
G9661003004illness, and/or the patient is considered high risk, and/or to follow-up on                                                                                                                                                                                                                                          
G9661004004previously diagnosed advance lesions                                                                                                                                                                                                                                                                                 
G9662001003Previously diagnosed or have an active diagnosis of clinical ascvd              Prior dx/active clin ascvd  00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9663001003Any fasting or direct ldl-c laboratory test result = 190 mg/dl                  Fast/dir ldl = 190 mg/dl    00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9664001003Patients who are currently statin therapy users or received an order            Taking statin or rec'd order00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9664002004(prescription) for statin therapy                                                                                                                                                                                                                                                                                    
G9665001003Patients who are not currently statin therapy users or did not receive an order No statin/no order statin   00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9665002004(prescription) for statin therapy                                                                                                                                                                                                                                                                                    
G9666001003The highest fasting or direct ldl-c laboratory test result of 70-189 mg/dl in   Fas/dir ldl 70-189mg/dl mst 00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9666002004the measurement period or two years prior to the beginning of the measurement                                                                                                                                                                                                                                        
G9666003004period                                                                                                                                                                                                                                                                                                               
G9667001003Documentation of medical reason(s) for not currently being a statin   therapy   Doc med rsn no stat tx/presc00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9667002004user or receive an order (prescription) for statin therapy (e.g., patient with                                                                                                                                                                                                                                       
G9667003004adverse effect, allergy or intolerance to statin medication therapy, patients                                                                                                                                                                                                                                        
G9667004004who have an active diagnosis of pregnancy or who are breastfeeding, patients                                                                                                                                                                                                                                         
G9667005004who are receiving palliative care, patients with active liver disease or                                                                                                                                                                                                                                             
G9667006004hepatic disease or insufficiency, patients with end stage renal disease (esrd),                                                                                                                                                                                                                                      
G9667007004and patients with diabetes who have a fasting or direct ldl-c laboratory test                                                                                                                                                                                                                                        
G9667008004result < 70 mg/dl and are not taking statin therapy)                                                                                                                                                                                                                                                                 
G9669001003I intend to report the multiple chronic conditions measures group               Intend rpt mult chr msr grp 00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9670001003All quality actions for the applicable measures in the multiple chronic         Qty act mcc mg perf         00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9670002004conditions measures group have been performed for this patient                                                                                                                                                                                                                                                       
G9671001003I intend to report the diabetic retinopathy measures group                      Intend rpt dia retin msr grp00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9672001003All quality actions for the applicable measures in the diabetic retinopathy     Qty act diab retin mg perf  00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9672002004measures group have been performed for this patient                                                                                                                                                                                                                                                                  
G9673001003I intend to report the cardiovascular prevention measures group                 Intend rpt card prev msr grp00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9674001003Patients with clinical ascvd diagnosis                                          Pt w/clin ascvd dx          00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9675001003Patients who have ever had a fasting or direct laboratory result of ldl-c = 190 Pt w/fast/dir lab ldl-c >19000      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9675002004mg/dl                                                                                                                                                                                                                                                                                                                
G9676001003Patients aged 40 to 75 years at the beginning of the measurement period with    40-75y w/type 1/2 w/ldl-c rs00      9                                                                                                     C                          Z2  1      02016010120160101        N                           
G9676002004type 1 or type 2 diabetes and with an ldl-c result of 70?189 mg/dl recorded as                                                                                                                                                                                                                                       
G9676003004the highest fasting or direct laboratory test result in the measurement year or                                                                                                                                                                                                                                      
G9676004004during the two years prior to the beginning of the measurement period                                                                                                                                                                                                                                                
G9677001003All quality actions for the applicable measures in the cardiovascular           Qty act card prev mg perf   00      9                                                                                                     C                          Z2  1      0201601012017010120161231N                           
G9677002004prevention measures group have been performed for this patient                                                                                                                                                                                                                                                       
G9678001003Oncology care model (ocm) monthly enhanced oncology services (meos) payment for Oncology care model service 00      9                                                                                                     C                          Z2  1      02016040120160401        N                           
G9678002004 ocm enhanced services.  g9678 payments may only be made to ocm practitioners                                                                                                                                                                                                                                        
G9678003004for ocm beneficiaries for the furnishment of enhanced services as defined in                                                                                                                                                                                                                                         
G9678004004the ocm participation agreement                                                                                                                                                                                                                                                                                      
G9679001003This code is for onsite acute care treatment of a nursing facility resident     Acute care pneumonia        00      9                                                                                                     C                          Z2  1      02016100120161001        N                           
G9679002004with pneumonia; may only be billed once per day per beneficiary                                                                                                                                                                                                                                                      
G9680001003This code is for onsite acute care treatment of a nursing facility resident     Acute care congestive heart 00      9                                                                                                     C                          Z2  1      02016100120161001        N                           
G9680002004with chf; may only be billed once per day per beneficiary                                                                                                                                                                                                                                                            
G9681001003This code is for onsite acute care treatment of a resident with copd or asthma; Acute care chronic obstruct 00      9                                                                                                     C                          Z2  1      02016100120161001        N                           
G9681002004may only be billed once per day per beneficiary                                                                                                                                                                                                                                                                      
G9682001003This code is for the onsite acute care treatment a nursing facility resident    Acute care skin infection   00      9                                                                                                     C                          Z2  1      02016100120161001        N                           
G9682002004with a skin infection; may only be billed once per day per beneficiary                                                                                                                                                                                                                                               
G9683001003Facility service(s) for the onsite acute care treatment of a nursing facility   Acute fluid/electro disorder00      9                                                                                                     C                          Z2  1      02016100120190101        C                           
G9683002004resident with fluid or electrolyte disorder. (may only be billed once per day                                                                                                                                                                                                                                        
G9683003004per beneficiary). this service is for a demonstration project                                                                                                                                                                                                                                                        
G9684001003This code is for the onsite acute care treatment of a nursing facility resident Acute care urinary tract inf00      9                                                                                                     C                          Z2  1      02016100120161001        N                           
G9684002004for a uti; may only be billed once per day per beneficiary                                                                                                                                                                                                                                                           
G9685001003Physician service or other qualified health care professional for the           Acute nursing facility care 00      9                                                                                                     C                          Z2  1      02016100120190101        C                           
G9685002004evaluation and management of a beneficiary's acute change in condition in a                                                                                                                                                                                                                                          
G9685003004nursing facility. this service is for a demonstration project                                                                                                                                                                                                                                                        
G9686001003Onsite nursing facility conference, that is separate and distinct from an       Nursing facility conference 00      9                                                                                                     C                          Z2  1      0201610012019010120181231D                           
G9686002004evaluation and management visit, including qualified practitioner and at least                                                                                                                                                                                                                                       
G9686003004one member of the nursing facility interdisciplinary care team                                                                                                                                                                                                                                                       
G9687001003Hospice services provided to patient any time during the measurement period     Hospice anytime msmt per    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9688001003Patients using hospice services any time during the measurement period          Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9689001003Patient admitted for performance of elective carotid intervention               Inpt elect carotid intervent00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9690001003Patient receiving hospice services any time during the measurement period       Pt in hos                   00      9                                                                                                     C                          Z2  1      02017010120190101        S                           
G9691001003Patient had hospice services any time during the measurement period             Pt hosp dur msmt period     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9692001003Hospice services received by patient any time during the measurement period     Hosp recd by pt dur msmt per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9693001003Patient use of hospice services any time during the measurement period          Pt use hosp during msmt per 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9694001003Hospice services utilized by patient any time during the measurement period     Hosp srv used pt in msmt per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9695001003Long-acting inhaled bronchodilator prescribed                                   Long act inhal bronchdil pre00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9696001003Documentation of medical reason(s) for not prescribing a long-acting inhaled    Med rsn no presc bronchdil  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9696002004bronchodilator                                                                                                                                                                                                                                                                                                       
G9697001003Documentation of patient reason(s) for not prescribing a long-acting inhaled    Pt rsn no presc bronchdil   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9697002004bronchodilator                                                                                                                                                                                                                                                                                                       
G9698001003Documentation of system reason(s) for not prescribing a long-acting inhaled     Sys rsn no presc bronchdil  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9698002004bronchodilator                                                                                                                                                                                                                                                                                                       
G9699001003Long-acting inhaled bronchodilator not prescribed, reason not otherwise         Long inhal bronchdil no pres00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9699002004specified                                                                                                                                                                                                                                                                                                            
G9700001003Patients who use hospice services any time during the measurement period        Pt is w/hosp during msmt per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9701001003Children who are taking antibiotics in the 30 days prior to the date of the     Child anbx 30 prior dx estab00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9701002004encounter during which the diagnosis was established                                                                                                                                                                                                                                                                 
G9702001003Patients who use hospice services any time during the measurement period        Pt use hosp during msmt per 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9703001003Children who are taking antibiotics in the 30 days prior to the  diagnosis of   Child anbx 30 prior dx phary00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9703002004pharyngitis                                                                                                                                                                                                                                                                                                          
G9704001003Ajcc breast cancer stage i: t1 mic or t1a documented                            Ajcc br ca stg i: t1 mic/t1a00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9705001003Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest         Ajcc br ca stg ib           00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9705002004dimension) documented                                                                                                                                                                                                                                                                                                
G9706001003Low (or very low) risk of recurrence, prostate cancer                           Low recur prost ca          00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9707001003Patient received hospice services any time during the measurement period        Pt had hosp dur msmt per    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9708001003Women who had a bilateral mastectomy or who have a history of a bilateral       Bilat mast/hx bi /unilat mas00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9708002004mastectomy or for whom there is evidence of a right and a left unilateral                                                                                                                                                                                                                                            
G9708003004mastectomy                                                                                                                                                                                                                                                                                                           
G9709001003Hospice services used by patient any time during the measurement period         Hosp srv used pt in msmt per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9710001003Patient was provided hospice services any time during the measurement period    Pt prov hosp srv msmt per   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9711001003Patients with a diagnosis or past history of total colectomy or colorectal      Pt hx tot col or colon ca   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9711002004cancer                                                                                                                                                                                                                                                                                                               
G9712001003Documentation of medical reason(s) for prescribing or dispensing antibiotic     Doc med rsn presc anbx      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9712002004(e.g., intestinal   infection, pertussis, bacterial infection, lyme disease,                                                                                                                                                                                                                                         
G9712003004otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic                                                                                                                                                                                                                                         
G9712004004sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis,                                                                                                                                                                                                                                            
G9712005004cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin                                                                                                                                                                                                                                         
G9712006004staph infections, pneumonia, gonococcal infections/venereal disease (syphilis,                                                                                                                                                                                                                                       
G9712007004chlamydia, inflammatory diseases [female reproductive organs]), infections of                                                                                                                                                                                                                                        
G9712008004the kidney, cystitis/uti, acne, hiv disease/asymptomatic hiv, cystic fibrosis,                                                                                                                                                                                                                                       
G9712009004disorders of the immune system, malignancy neoplasms, chronic bronchitis,                                                                                                                                                                                                                                            
G9712010004emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway                                                                                                                                                                                                                                             
G9712011004obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease                                                                                                                                                                                                                                       
G9712012004due to external agents, other diseases of the respiratory system, and                                                                                                                                                                                                                                                
G9712013004tuberculosis                                                                                                                                                                                                                                                                                                         
G9713001003Patients who use hospice services any time during the measurement period        Pt use hosp during msmt per 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9714001003Patient is using hospice services any time during the measurement period        Pt is w/hosp during msmt per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9715001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9716001003Bmi is documented as being outside of normal limits, follow-up plan is not      Bmi doc onl fup not cmpltd  00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9716002004completed for documented reason                                                                                                                                                                                                                                                                                      
G9717001003Documentation stating the patient has an active diagnosis of depression or has  Doc pt dx dep/bp f/u nt req 00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9717002004a diagnosed bipolar disorder, therefore screening or follow-up not required                                                                                                                                                                                                                                          
G9718001003Hospice services for patient provided any time during the measurement period    Hospice anytime msmt per    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9719001003Patient is not ambulatory, bed ridden, immobile, confined to chair, wheelchair  Pt not ambul/immob/wc       00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9719002004bound, dependent on helper pushing wheelchair, independent in wheelchair or                                                                                                                                                                                                                                          
G9719003004minimal help in wheelchair                                                                                                                                                                                                                                                                                           
G9720001003Hospice services for patient occurred any time during the measurement period    Hospice anytime msmt per    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9721001003Patient not ambulatory, bed ridden, immobile, confined to chair, wheelchair     Pt not ambul/immob/wc       00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9721002004bound, dependent on helper pushing wheelchair, independent in wheelchair or                                                                                                                                                                                                                                          
G9721003004minimal help in wheelchair                                                                                                                                                                                                                                                                                           
G9722001003Documented history of renal failure or baseline serum creatinine = 4.0 mg/dl;   Doc hx renal fail or cr+ >4 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9722002004renal transplant recipients are not considered to have preoperative renal                                                                                                                                                                                                                                            
G9722003004failure, unless, since transplantation the cr has been or is 4.0 or higher                                                                                                                                                                                                                                           
G9723001003Hospice services for patient received any time during the measurement period    Hosp recd by pt dur msmt per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9724001003Patients who had documentation of use of anticoagulant medications overlapping  Pt w/doc use anticoag mst yr00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9724002004the measurement year                                                                                                                                                                                                                                                                                                 
G9725001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9726001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9727001003Patient unable to complete the knee fs prom at admission and discharge due to   Pt unable cmplt knee fs prom00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9727002004blindness, illiteracy, severe mental incapacity or language incompatibility and                                                                                                                                                                                                                                      
G9727003004an adequate proxy is not available                                                                                                                                                                                                                                                                                   
G9728001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9729001003Patient unable to complete the hip fs prom at admission and discharge due to    Pt unbl cmplt hip fs prom   00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9729002004blindness, illiteracy, severe mental incapacity or language incompatibility and                                                                                                                                                                                                                                      
G9729003004an adequate proxy is not available                                                                                                                                                                                                                                                                                   
G9730001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9731001003Patient unable to complete the foot/ankle fs prom at admission and discharge    Pt unbl cmplt ft/ank fs prom00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9731002004due to blindness, illiteracy, severe mental incapacity or language                                                                                                                                                                                                                                                   
G9731003004incompatibility and an adequate proxy is not available                                                                                                                                                                                                                                                               
G9732001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9733001003Patient unable to complete the low back fs prom at admission and discharge due  Pt unbl cmplt lb fs prom    00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9733002004to blindness, illiteracy, severe mental incapacity or language incompatibility                                                                                                                                                                                                                                       
G9733003004and an adequate proxy is not available                                                                                                                                                                                                                                                                               
G9734001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9735001003Patient unable to complete the shoulder fs prom at admission and discharge due  Pt unbl cmplt shld fs prom  00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9735002004to blindness, illiteracy, severe mental incapacity or language incompatibility                                                                                                                                                                                                                                       
G9735003004and an adequate proxy is not available                                                                                                                                                                                                                                                                               
G9736001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9737001003Patient unable to complete the elbow/wrist/hand fs prom at admission and        Pt unbl cmplt ewh fs prom   00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9737002004discharge due to blindness, illiteracy, severe mental incapacity or language                                                                                                                                                                                                                                         
G9737003004incompatibility and an adequate proxy is not available                                                                                                                                                                                                                                                               
G9738001003Patient refused to participate                                                  Refused to participate      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9739001003Patient unable to complete the general orthopedic fs prom at admission and      Pt unbl cmplt go fs prom    00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9739002004discharge due to blindness, illiteracy, severe mental incapacity or language                                                                                                                                                                                                                                         
G9739003004incompatibility and an adequate proxy is not available                                                                                                                                                                                                                                                               
G9740001003Hospice services given to patient any time during the measurement period        Hosp srv to pt dur msmt per 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9741001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9742001003Psychiatric symptoms assessed                                                   Psych sympt assessed        00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9743001003Psychiatric symptoms not assessed, reason not otherwise specified               Psych symp not assessed, rns00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9744001003Patient not eligible due to active diagnosis of hypertension                    Pt not eli d/t act dig htn  00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9745001003Documented reason for not screening or recommending a follow-up for high blood  Doc rsn no hbp scrn or f/u  00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9745002004pressure                                                                                                                                                                                                                                                                                                             
G9746001003Patient has mitral stenosis or prosthetic heart valves or patient has transient Mit sten, valve or trans af 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9746002004or reversible cause of af (e.g., pneumonia, hyperthyroidism, pregnancy, cardiac                                                                                                                                                                                                                                      
G9746003004surgery)                                                                                                                                                                                                                                                                                                             
G9747001003Patient is undergoing palliative dialysis with a catheter                       Pall dialysis with catheter 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9748001003Patient approved by a qualified transplant program and scheduled to receive a   App transpl lvg kidney donor00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9748002004living donor kidney transplant                                                                                                                                                                                                                                                                                       
G9749001003Patient is undergoing palliative dialysis with a catheter                       Pall dialysis with catheter 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9750001003Patient approved by a qualified transplant program and scheduled to receive a   App transpl lvg kidney donor00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9750002004living donor kidney transplant                                                                                                                                                                                                                                                                                       
G9751001003Patient died at any time during the 24-month measurement period                 Pt died w/in 24 mos rpt time00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9752001003Emergency surgery                                                               Urgent surgery              00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9753001003Documentation of medical reason for not conducting a search for dicom format    Doc no dicom, ct other fac  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9753002004images for prior patient ct imaging studies completed at non-affiliated                                                                                                                                                                                                                                              
G9753003004external healthcare facilities or entities within the past 12 months that are                                                                                                                                                                                                                                        
G9753004004available through a secure, authorized, media-free, shared archive (e.g.,                                                                                                                                                                                                                                            
G9753005004trauma, acute myocardial infarction, stroke, aortic aneurysm where time is of                                                                                                                                                                                                                                        
G9753006004the essence)                                                                                                                                                                                                                                                                                                         
G9754001003A finding of an incidental pulmonary nodule                                     Incid pulm nodule           00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9755001003Documentation of medical reason(s) for not including a recommended interval and Doc med rsn no fllw up      00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9755002004modality for follow-up or for no follow-up, and source of recommendations                                                                                                                                                                                                                                            
G9755003004(e.g., patients with unexplained fever, immunocompromised patients who are at                                                                                                                                                                                                                                        
G9755004004risk for infection)                                                                                                                                                                                                                                                                                                  
G9756001003Surgical procedures that included the use of silicone oil                       Surg proc w/silicone oil    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9757001003Surgical procedures that included the use of silicone oil                       Surg proc w/silicone oil    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9758001003Patient in hospice at any time during the measurement period                    Pt in hos                   00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9759001003History of preoperative posterior capsule rupture                               Hx preop post cap rup       00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9760001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9761001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9762001003Patient had at least two hpv vaccines (with at least 146 days between the two)  Pt had >= 2-3 hpv vaccines  00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9762002004or three hpv vaccines on or between the patient's 9th and 13th birthdays                                                                                                                                                                                                                                             
G9763001003Patient did not have at least two hpv vaccines (with at least 146 days between  Pt not have 2-3 hpv vaccines00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9763002004the two) or three hpv vaccines on or between the patient's 9th and 13th                                                                                                                                                                                                                                              
G9763003004birthdays                                                                                                                                                                                                                                                                                                            
G9764001003Patient has been treated with a systemic medication for psoriasis vulgaris      Pt treatd w/oral syst or bio00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9765001003Documentation that the patient declined change in medication or alternative     Doc pat declined therapy    00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9765002004therapies were unavailable, has documented contraindications, or has not been                                                                                                                                                                                                                                        
G9765003004treated with a systemic medication for at least six consecutive months (e.g.,                                                                                                                                                                                                                                        
G9765004004experienced adverse effects or lack of efficacy with all other therapy options)                                                                                                                                                                                                                                      
G9765005004in order to achieve better disease control as measured by pga, bsa, pasi, or                                                                                                                                                                                                                                         
G9765006004dlqi                                                                                                                                                                                                                                                                                                                 
G9766001003Patients who are transferred from one institution to another with a known       Cva stroke dx tx transf fac 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9766002004diagnosis of cva for endovascular stroke treatment                                                                                                                                                                                                                                                                   
G9767001003Hospitalized patients with newly diagnosed cva considered for endovascular      Hosp new dx cva consid evst 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9767002004stroke treatment                                                                                                                                                                                                                                                                                                     
G9768001003Patients who utilize hospice services any time during the measurement period    Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9769001003Patient had a bone mineral density test in the past two years or received       Bn den 2yr/got ost med/ther 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9769002004osteoporosis medication or therapy in the past 12 months                                                                                                                                                                                                                                                             
G9770001003Peripheral nerve block (pnb)                                                    Perip nerve block           00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9771001003At least 1 body temperature measurement equal to or greater than 35.5 degrees   Anes end, 1 temp >35.5(95.9)00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9771002004celsius (or 95.9 degrees fahrenheit) achieved within the 30 minutes immediately                                                                                                                                                                                                                                      
G9771003004before or the 15 minutes immediately after anesthesia end time                                                                                                                                                                                                                                                       
G9772001003Documentation of one of the following medical reason(s) for not achieving at    Doc med rsn no temp >= 35.5 00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9772002004least 1 body temperature measurement equal to or greater than 35.5 degrees                                                                                                                                                                                                                                           
G9772003004celsius (or 95.9 degrees fahrenheit) within the 30 minutes immediately before                                                                                                                                                                                                                                        
G9772004004or the 15 minutes immediately after anesthesia end time (e.g., emergency cases,                                                                                                                                                                                                                                      
G9772005004intentional hypothermia, etc.)                                                                                                                                                                                                                                                                                       
G9773001003At least 1 body temperature measurement equal to or greater than 35.5 degrees   1 bod temp >=35.5           00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9773002004celsius (or 95.9 degrees fahrenheit) not achieved within the 30 minutes                                                                                                                                                                                                                                              
G9773003004immediately before or the 15 minutes immediately after anesthesia end time,                                                                                                                                                                                                                                          
G9773004004reason not given                                                                                                                                                                                                                                                                                                     
G9774001003Patients who have had a hysterectomy                                            Pt had hyst                 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9775001003Patient received at least 2 prophylactic pharmacologic anti-emetic agents of    Recd 2 anti-emet pre/intraop00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9775002004different classes preoperatively and/or intraoperatively                                                                                                                                                                                                                                                             
G9776001003Documentation of medical reason for not receiving at least 2 prophylactic       Doc med rsn no proph antiem 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9776002004pharmacologic anti-emetic agents of different classes preoperatively and/or                                                                                                                                                                                                                                          
G9776003004intraoperatively  (e.g., intolerance or other medical reason)                                                                                                                                                                                                                                                        
G9777001003Patient did not receive at least 2 prophylactic pharmacologic anti-emetic       Pt no antiemet pre/intraop  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9777002004agents of different classes preoperatively and/or intraoperatively                                                                                                                                                                                                                                                   
G9778001003Patients who have a diagnosis of pregnancy                                      Pts dx w/pregn              00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9779001003Patients who are breastfeeding                                                  Pts breastfeeding           00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9780001003Patients who have a diagnosis of rhabdomyolysis                                 Pts dx w/rhabdomyolysis     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9781001003Documentation of medical reason(s) for not currently being a statin therapy     Doc rsn no statin           00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9781002004user or receive an order (prescription) for statin therapy (e.g., patient with                                                                                                                                                                                                                                       
G9781003004adverse effect, allergy or intolerance to statin medication therapy, patients                                                                                                                                                                                                                                        
G9781004004who are receiving palliative care, patients with active liver disease or                                                                                                                                                                                                                                             
G9781005004hepatic disease or insufficiency, and patients with end stage renal disease                                                                                                                                                                                                                                          
G9781006004(esrd))                                                                                                                                                                                                                                                                                                              
G9782001003History of or active diagnosis of familial or pure hypercholesterolemia         Hx dx fam/pure hypercholes  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9783001003Documentation of patients with diabetes who have a most recent fasting or       Doc dx dm, fast <70, no stat00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9783002004direct ldl- c laboratory test result < 70 mg/dl and are not taking statin                                                                                                                                                                                                                                            
G9783003004therapy                                                                                                                                                                                                                                                                                                              
G9784001003Pathologists/dermatopathologists providing a second opinion on a biopsy         Path/derm prov 2nd biop opin00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9785001003Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell     Pathology report sent       00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9785002004carcinoma (to include in situ disease) sent from the                                                                                                                                                                                                                                                                 
G9785003004pathologist/dermatopathologist to the biopsying clinician for review within 7                                                                                                                                                                                                                                        
G9785004004days from the time when the tissue specimen was received by the pathologist                                                                                                                                                                                                                                          
G9786001003Pathology report diagnosing cutaneous basal cell carcinoma or squamous cell     Pathology report not sent   00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9786002004carcinoma (to include in situ disease) was not sent from the                                                                                                                                                                                                                                                         
G9786003004pathologist/dermatopathologist to the biopsying clinician for review within 7                                                                                                                                                                                                                                        
G9786004004days from the time when the tissue specimen was received by the pathologist                                                                                                                                                                                                                                          
G9787001003Patient alive as of the last day of the measurement year                        Pt alive                    00      9                                                                                                     C                          Z2  1      02017010120190101        S                           
G9788001003Most recent bp is less than or equal to 140/90 mm hg                            Most rct bp </= 140/90      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9789001003Blood pressure recorded during inpatient stays, emergency room visits, urgent   Record bp ip, er, urg/self  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9789002004care visits, and patient self-reported bp's (home and health fair bp results)                                                                                                                                                                                                                                        
G9790001003Most recent bp is greater than 140/90 mm hg, or blood pressure not documented   Most rct bp >/= 140/90      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9791001003Most recent tobacco status is tobacco free                                      Most rct tob stat free      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9792001003Most recent tobacco status is not tobacco free                                  Most rct tob stat not free  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9793001003Patient is currently on a daily aspirin or other antiplatelet                   Pt on daily asa/antiplat    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9794001003Documentation of medical reason(s) for not on a daily aspirin or other          Doc med rsn no daily aspirin00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9794002004antiplatelet (e.g., history of gastrointestinal bleed, intra-cranial bleed,                                                                                                                                                                                                                                          
G9794003004idiopathic thrombocytopenic purpura (itp), gastric bypass or documentation of                                                                                                                                                                                                                                        
G9794004004active anticoagulant use during the measurement period)                                                                                                                                                                                                                                                              
G9795001003Patient is not currently on a daily aspirin or other antiplatelet               Pt no daily asa/antiplat    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9796001003Patient is currently on a statin therapy                                        Pt not currently on statin  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9797001003Patient is not on a statin therapy                                              Pt currently on statin      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9798001003Discharge(s) for ami between july 1 of the year prior measurement year to june  D/c ami btw 7/1-6/30 mst per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G979800200430 of the measurement period                                                                                                                                                                                                                                                                                         
G9799001003Patients with a medication dispensing event indicator of a history of asthma    Med disp evt indic hx asth  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9799002004any time during the patient's history through the end of the measure period                                                                                                                                                                                                                                          
G9800001003Patients who are identified as having an intolerance or allergy to beta-blocker Pt id intol/alleg beta-block00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9800002004therapy                                                                                                                                                                                                                                                                                                              
G9801001003Hospitalizations in which the patient was transferred directly to a non-acute   Nonacut transf from inpt    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9801002004care facility for any diagnosis                                                                                                                                                                                                                                                                                      
G9802001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9803001003Patient prescribed at least a 135 day treatment within the 180-day measurement  Pt presc 135 day trmt       00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9803002004interval with beta-blockers post-discharge for ami                                                                                                                                                                                                                                                                   
G9804001003Patient was not prescribed at least a 135 day treatment within the 180-day      Pt not presc 135 day trmt   00      9                                                                                                     C                          Z2  1      02017010120190101        C                           
G9804002004measurement interval with beta-blockers post-discharge for ami                                                                                                                                                                                                                                                       
G9805001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9806001003Patients who received cervical cytology or an hpv test                          Pt recd cerv cyto/hpv       00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9807001003Patients who did not receive cervical cytology or an hpv test                   Pt no recd cerv cyto/hpv    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9808001003Any patients who had no asthma controller medications dispensed during the      Pt no asthm cont med mst per00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9808002004measurement year                                                                                                                                                                                                                                                                                                     
G9809001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9810001003Patient achieved a pdc of at least 75% for their asthma controller medication   Pdc 75% w/asth cont med     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9811001003Patient did not achieve a pdc of at least 75% for their asthma controller       No pdc 75% w/asth cont med  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9811002004medication                                                                                                                                                                                                                                                                                                           
G9812001003Patient died including all deaths occurring during the hospitalization in which Pt died during inpt/30d aft 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9812002004the operation was performed, even if after 30 days, and those deaths occurring                                                                                                                                                                                                                                       
G9812003004after discharge from the hospital, but within 30 days of the procedure                                                                                                                                                                                                                                               
G9813001003Patient did not die within 30 days of the procedure or during the index         Pt not died w/in 30d of proc00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9813002004hospitalization                                                                                                                                                                                                                                                                                                      
G9814001003Death occurring during the index acute care hospitalization                     Death during index hosp     00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9815001003Death did not occur during the index acute care hospitalization                 Death not during index hosp 00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9816001003Death occurring after discharge from the hospital but within 30 days post       Death <30 day post discharge00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9816002004procedure                                                                                                                                                                                                                                                                                                            
G9817001003Death did not occur after discharge from the hospital within 30 days post       No death 30-days post-disch 00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9817002004procedure                                                                                                                                                                                                                                                                                                            
G9818001003Documentation of sexual activity                                                Doc sex activity            00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9819001003Patients who use hospice services any time during the measurement period        Pt w/hosp anytime msmt per  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9820001003Documentation of a chlamydia screening test with proper follow-up               Doc chlam scr test w/follow 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9821001003No documentation of a chlamydia screening test with proper follow-up            No doc chlam scr ts w/follow00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9822001003Women who had an endometrial ablation procedure during the year prior to the    Endo abl proc yr prev ind dt00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9822002004index date (exclusive of the index date)                                                                                                                                                                                                                                                                             
G9823001003Endometrial sampling or hysteroscopy with biopsy and results documented         Endo smpl/hyst bx res doc   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9824001003Endometrial sampling or hysteroscopy with biopsy and results not documented     Endo smpl/hyst bx res no doc00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9825001003Her-2/neu negative or undocumented/unknown                                      Her-2 neg,undoc/unkn        00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9826001003Patient transferred to practice after initiation of chemotherapy                Transf pract aft init chemo 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9827001003Her2-targeted therapies not administered during the initial course of treatment Her-2 targ ther no init tx  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9828001003Her2-targeted therapies administered during the initial course of treatment     Her-2 targ ther dur init tx 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9829001003Breast adjuvant chemotherapy administered                                       Breast adj chemo admin      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9830001003Her-2/neu positive                                                              Her-2 pos                   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9831001003Ajcc stage at breast cancer diagnosis = ii or iii                               Ajcc stg brt ca dx ii or iii00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9832001003Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast      Brt ca dx i, no t1/t1a/t1b  00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9832002004cancer diagnosis does not equal = t1, t1a, t1b                                                                                                                                                                                                                                                                       
G9833001003Patient transfer to practice after initiation of chemotherapy                   Transf pract aft init chemo 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9834001003Patient has metastatic disease at diagnosis                                     Pt met dis at dx            00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9835001003Trastuzumab administered within 12 months of diagnosis                          Trastuz given w/in 12 mos dx00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9836001003Reason for not administering trastuzumab documented (e.g. patient declined,     Rsn no trast given doc      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9836002004patient died, patient transferred, contraindication or other clinical                                                                                                                                                                                                                                                
G9836003004exclusion, neoadjuvant chemotherapy or radiation not complete)                                                                                                                                                                                                                                                       
G9837001003Trastuzumab not administered within 12 months of diagnosis                      Trastuz not in 12 mos dx    00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9838001003Patient has metastatic disease at diagnosis                                     Pt met dis at dx            00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9839001003Anti-egfr monoclonal antibody therapy                                           Anti-egfr mon anti ther     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9840001003Ras (kras and nras) gene mutation testing performed before initiation of        Gene testing performed      00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9840002004anti-egfr moab                                                                                                                                                                                                                                                                                                       
G9841001003Ras (kras and nras) gene mutation testing not performed before initiation of    Gene testing not performed  00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9841002004anti-egfr moab                                                                                                                                                                                                                                                                                                       
G9842001003Patient has metastatic disease at diagnosis                                     Pt met dis at dx            00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9843001003Ras (kras or nras) gene mutation                                                Kras or nras gene mutation  00      9                                                                                                     C                          Z2  1      02017010120180101        N                           
G9844001003Patient did not receive anti-egfr monoclonal antibody therapy                   Pt no recd anti-egfr ther   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9845001003Patient received anti-egfr monoclonal antibody therapy                          Pt recd anti-egfr ther      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9846001003Patients who died from cancer                                                   Pt died from cancer         00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9847001003Patient received chemotherapy in the last 14 days of life                       Pt recd chemo last 14d life 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9848001003Patient did not receive chemotherapy in the last 14 days of life                Pt no chemo last 14d life   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9849001003Patients who died from cancer                                                   Pt died from cancer         00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9850001003Patient had more than one emergency department visit in the last 30 days of life1/more ed last 30d life     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9851001003Patient had one or less emergency department visits in the last 30 days of life 1/no ed visit last 30d life 00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9852001003Patients who died from cancer                                                   Pt died from cancer         00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9853001003Patient admitted to the icu in the last 30 days of life                         Icu stay last 30d life      00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9854001003Patient was not admitted to the icu in the last 30 days of life                 No icu stay last 30d life   00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9855001003Patients who died from cancer                                                   Pt died from cancer         00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9856001003Patient was not admitted to hospice                                             Pt no hospice               00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9857001003Patient admitted to hospice                                                     Pt admit hospice            00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9858001003Patient enrolled in hospice                                                     Pt enroll hospice           00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9859001003Patients who died from cancer                                                   Pt died from cancer         00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9860001003Patient spent less than three days in hospice care                              Pt less 3d hospice          00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9861001003Patient spent greater than or equal to three days in hospice care               Pt more than 3d hospice     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9862001003Documentation of medical reason(s) for not recommending at least a 10 year      Doc rsn no 10 yr follow     00      9                                                                                                     C                          Z2  1      02017010120170101        N                           
G9862002004follow-up interval (e.g., inadequate prep, familial or personal history of                                                                                                                                                                                                                                           
G9862003004colonic polyps, patient had no adenoma and age is = 66 years old, or life                                                                                                                                                                                                                                            
G9862004004expectancy < 10 years old, other medical reasons)                                                                                                                                                                                                                                                                    
G9868001003Receipt and analysis of remote, asynchronous images for dermatologic and/or     Next gen aco model <10min   13      A                                                                                                     C                          M5D 1      02018010120180101        N                           
G9868002004ophthalmologic evaluation, for use under the next generation aco model, less                                                                                                                                                                                                                                         
G9868003004than 10 minutes                                                                                                                                                                                                                                                                                                      
G9869001003Receipt and analysis of remote, asynchronous images for dermatologic and/or     Next gen aco model 10-20min 13      A                                                                                                     C                          M5D 1      02018010120180101        N                           
G9869002004ophthalmologic evaluation, for use under the next generation aco model, 10-20                                                                                                                                                                                                                                        
G9869003004minutes                                                                                                                                                                                                                                                                                                              
G9870001003Receipt and analysis of remote, asynchronous images for dermatologic and/or     Next gen aco model >20min   13      A                                                                                                     C                          M5D 1      02018010120180101        N                           
G9870002004ophthalmologic evaluation, for use under the next generation aco model, 20 or                                                                                                                                                                                                                                        
G9870003004more minutes                                                                                                                                                                                                                                                                                                         
G9873001003First medicare diabetes prevention program (mdpp) core session was attended by  1 em core session           00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9873002004an mdpp beneficiary under the mdpp expanded model (em).  a core session is an                                                                                                                                                                                                                                        
G9873003004mdpp service that: (1)  is furnished by an mdpp supplier during months 1                                                                                                                                                                                                                                             
G9873004004through 6 of the mdpp services period; (2)  is approximately 1 hour in length;                                                                                                                                                                                                                                       
G9873005004and (3) adheres to a cdc-approved dpp curriculum for core sessions                                                                                                                                                                                                                                                   
G9874001003Four total medicare diabetes prevention program (mdpp) core sessions were       4 em core sessions          00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9874002004attended by an mdpp beneficiary under the mdpp expanded model (em).  a core                                                                                                                                                                                                                                          
G9874003004session is an mdpp service that: (1)  is furnished by an mdpp supplier during                                                                                                                                                                                                                                        
G9874004004months 1 through 6 of the mdpp services period; (2)  is approximately 1 hour in                                                                                                                                                                                                                                      
G9874005004length; and (3) adheres to a cdc-approved dpp curriculum for core sessions                                                                                                                                                                                                                                           
G9875001003Nine total medicare diabetes prevention program (mdpp) core sessions were       9 em core sessions          00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9875002004attended by an mdpp beneficiary under the mdpp expanded model (em).  a core                                                                                                                                                                                                                                          
G9875003004session is an mdpp service that: (1)  is furnished by an mdpp supplier during                                                                                                                                                                                                                                        
G9875004004months 1 through 6 of the mdpp services period; (2)  is approximately 1 hour in                                                                                                                                                                                                                                      
G9875005004length; and (3) adheres to a cdc-approved dpp curriculum for core sessions                                                                                                                                                                                                                                           
G9876001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms)  2 em core ms mo 7-9 no wl   00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9876002004were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded                                                                                                                                                                                                                                      
G9876003004model (em).  a core maintenance session is an mdpp service that: (1) is                                                                                                                                                                                                                                              
G9876004004furnished by an mdpp supplier during months 7 through 12 of the mdpp services                                                                                                                                                                                                                                        
G9876005004period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                                  
G9876006004cdc-approved dpp curriculum for maintenance sessions.  the beneficiary did not                                                                                                                                                                                                                                       
G9876007004achieve at least 5% weight loss (wl) from his/her baseline weight, as measured                                                                                                                                                                                                                                       
G9876008004by at least one in-person weight measurement at a core maintenance session in                                                                                                                                                                                                                                        
G9876009004months 7-9                                                                                                                                                                                                                                                                                                           
G9877001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms)  2 em core ms mo 10-12 no wl 00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9877002004were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp                                                                                                                                                                                                                                             
G9877003004expanded model (em).  a core maintenance session is an mdpp service that: (1)                                                                                                                                                                                                                                        
G9877004004is furnished by an mdpp supplier during months 7 through 12 of the mdpp                                                                                                                                                                                                                                              
G9877005004services period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                         
G9877006004cdc-approved dpp curriculum for maintenance sessions.  the beneficiary did not                                                                                                                                                                                                                                       
G9877007004achieve at least 5% weight loss (wl) from his/her baseline weight, as measured                                                                                                                                                                                                                                       
G9877008004by at least one in-person weight measurement at a core maintenance session in                                                                                                                                                                                                                                        
G9877009004months 10-12                                                                                                                                                                                                                                                                                                         
G9878001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms)  2 em core ms mo 7-9 wl      00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9878002004were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded                                                                                                                                                                                                                                      
G9878003004model (em).  a core maintenance session is an mdpp service that: (1) is                                                                                                                                                                                                                                              
G9878004004furnished by an mdpp supplier during months 7 through 12 of the mdpp services                                                                                                                                                                                                                                        
G9878005004period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                                  
G9878006004cdc-approved dpp curriculum for maintenance sessions.the beneficiary achieved                                                                                                                                                                                                                                        
G9878007004at least 5% weight loss (wl) from his/her baseline weight, as measured by at                                                                                                                                                                                                                                         
G9878008004least one in-person weight measurement at a core maintenance session in months                                                                                                                                                                                                                                       
G98780090047-9                                                                                                                                                                                                                                                                                                                  
G9879001003Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms)  2 em core ms mo 10-12 wl    00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9879002004were attended by an mdpp beneficiary in months (mo) 10-12 under the mdpp                                                                                                                                                                                                                                             
G9879003004expanded model (em).  a core maintenance session is an mdpp service that: (1)                                                                                                                                                                                                                                        
G9879004004is furnished by an mdpp supplier during months 7 through 12 of the mdpp                                                                                                                                                                                                                                              
G9879005004services period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                         
G9879006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary achieved                                                                                                                                                                                                                                       
G9879007004at least 5% weight loss (wl) from his/her baseline weight, as measured by at                                                                                                                                                                                                                                         
G9879008004least one in-person weight measurement at a core maintenance session in months                                                                                                                                                                                                                                       
G987900900410-12                                                                                                                                                                                                                                                                                                                
G9880001003The mdpp beneficiary achieved at least 5% weight loss (wl) from his/her         Em 5 percent wl             00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9880002004baseline weight in months 1-12 of the mdpp services period under the mdpp                                                                                                                                                                                                                                            
G9880003004expanded model (em).  this is a one-time payment available when a beneficiary                                                                                                                                                                                                                                        
G9880004004first achieves at least 5% weight loss from baseline as measured by an                                                                                                                                                                                                                                               
G9880005004in-person weight measurement at a core session or core maintenance session                                                                                                                                                                                                                                           
G9881001003The mdpp beneficiary achieved at least 9% weight loss (wl) from his/her         Em 9 percent wl             00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9881002004baseline weight in months 1-24 under the mdpp expanded model (em).  this is a                                                                                                                                                                                                                                        
G9881003004one-time payment available when a beneficiary first achieves at least 9% weight                                                                                                                                                                                                                                      
G9881004004loss from baseline as measured by an in-person weight measurement at a core                                                                                                                                                                                                                                          
G9881005004session, core maintenance session, or ongoing maintenance session                                                                                                                                                                                                                                                    
G9882001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions    2 em ongoing ms mo 13-15 wl 00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9882002004(ms) were attended by an mdpp beneficiary in months (mo) 13-15 under the mdpp                                                                                                                                                                                                                                        
G9882003004expanded model (em).  an ongoing maintenance session is an mdpp service that:                                                                                                                                                                                                                                        
G9882004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp                                                                                                                                                                                                                                         
G9882005004services period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                         
G9882006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary                                                                                                                                                                                                                                                
G9882007004maintained at least 5% weight loss (wl) from his/her baseline weight, as                                                                                                                                                                                                                                             
G9882008004measured by at least one in-person weight measurement at an ongoing maintenance                                                                                                                                                                                                                                      
G9882009004session in months 13-15                                                                                                                                                                                                                                                                                              
G9883001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions    2 em ongoing ms mo 16-18 wl 00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9883002004(ms) were attended by an mdpp beneficiary in months (mo) 16-18 under the mdpp                                                                                                                                                                                                                                        
G9883003004expanded model (em).  an ongoing maintenance session is an mdpp service that:                                                                                                                                                                                                                                        
G9883004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp                                                                                                                                                                                                                                         
G9883005004services period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                         
G9883006004cdc-approved dpp curriculum for maintenance sessions.  the beneficiary                                                                                                                                                                                                                                               
G9883007004maintained at least 5% weight loss (wl) from his/her baseline weight, as                                                                                                                                                                                                                                             
G9883008004measured by at least one in-person weight measurement at an ongoing maintenance                                                                                                                                                                                                                                      
G9883009004session in months 16-18                                                                                                                                                                                                                                                                                              
G9884001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions    2 em ongoing ms mo 19-21 wl 00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9884002004(ms) were attended by an mdpp beneficiary in months (mo) 19-21 under the mdpp                                                                                                                                                                                                                                        
G9884003004expanded model (em).  an ongoing maintenance session is an mdpp service that:                                                                                                                                                                                                                                        
G9884004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp                                                                                                                                                                                                                                         
G9884005004services period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                         
G9884006004cdc-approved dpp curriculum for maintenance sessions. the beneficiary                                                                                                                                                                                                                                                
G9884007004maintained at least 5% weight loss (wl) from his/her baseline weight, as                                                                                                                                                                                                                                             
G9884008004measured by at least one in-person weight measurement at an ongoing maintenance                                                                                                                                                                                                                                      
G9884009004session in months 19-21                                                                                                                                                                                                                                                                                              
G9885001003Two medicare diabetes prevention program (mdpp) ongoing maintenance sessions    2 em ongoing ms mo 22-24 wl 00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9885002004(ms) were attended by an mdpp beneficiary in months (mo) 22-24 under the mdpp                                                                                                                                                                                                                                        
G9885003004expanded model (em).  an ongoing maintenance session is an mdpp service that:                                                                                                                                                                                                                                        
G9885004004(1) is furnished by an mdpp supplier during months 13 through 24 of the mdpp                                                                                                                                                                                                                                         
G9885005004services period; (2) is approximately 1 hour in length; and (3) adheres to a                                                                                                                                                                                                                                         
G9885006004cdc-approved dpp curriculum for maintenance sessions.  the beneficiary                                                                                                                                                                                                                                               
G9885007004maintained at least 5% weight loss (wl) from his/her baseline weight, as                                                                                                                                                                                                                                             
G9885008004measured by at least one in-person weight measurement at an ongoing maintenance                                                                                                                                                                                                                                      
G9885009004session in months 22-24                                                                                                                                                                                                                                                                                              
G9890001003Bridge payment: a one-time payment for the first medicare diabetes prevention   Em bridge payment           00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9890002004program (mdpp) core session, core maintenance session, or ongoing maintenance                                                                                                                                                                                                                                        
G9890003004session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24                                                                                                                                                                                                                                      
G9890004004of the mdpp expanded model (em) who has previously received mdpp services from                                                                                                                                                                                                                                       
G9890005004a different mdpp supplier under the mdpp expanded model.  a supplier may only                                                                                                                                                                                                                                        
G9890006004receive one bridge payment per mdpp beneficiary                                                                                                                                                                                                                                                                      
G9891001003Mdpp session reported as a line-item on a claim for a payable mdpp expanded     Em session reporting        00      9                                                                                                     C                          Y1  1      02018040120180401        A                           
G9891002004model (em)  hcpcs code for a session furnished by the billing supplier under                                                                                                                                                                                                                                         
G9891003004the mdpp expanded model and counting toward achievement of the attendance                                                                                                                                                                                                                                            
G9891004004performance goal for the payable mdpp expanded model hcpcs code (this code is                                                                                                                                                                                                                                        
G9891005004for reporting purposes only)                                                                                                                                                                                                                                                                                         
G9892001003Documentation of patient reason(s) for not performing a dilated macular         Doc pt rsn no dil mac exam  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9892002004examination                                                                                                                                                                                                                                                                                                          
G9893001003Dilated macular exam was not performed, reason not otherwise specified          No mac exam                 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9894001003Androgen deprivation therapy prescribed/administered in combination with        Adr dep thrpy prescribed    00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9894002004external beam radiotherapy to the prostate                                                                                                                                                                                                                                                                           
G9895001003Documentation of medical reason(s) for not prescribing/administering androgen   Doc med rsn no adr dep thrpy00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9895002004deprivation therapy in combination with external beam radiotherapy to the                                                                                                                                                                                                                                            
G9895003004prostate (e.g., salvage therapy)                                                                                                                                                                                                                                                                                     
G9896001003Documentation of patient reason(s) for not prescribing/administering androgen   Doc pt rsn no adr dep thrpy 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9896002004deprivation therapy in combination with external beam radiotherapy to the                                                                                                                                                                                                                                            
G9896003004prostate                                                                                                                                                                                                                                                                                                             
G9897001003Patients who were not prescribed/administered androgen deprivation therapy in   Pt nt prsc adr dep thrpy rng00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9897002004combination with external beam radiotherapy to the prostate, reason not given                                                                                                                                                                                                                                        
G9898001003Patient age 65 or older in institutional special needs plans (snp) or residing  Snp/lg trm cre pt w/pos cde 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9898002004in long-term care with pos code 32, 33, 34, 54, or 56 any time during the                                                                                                                                                                                                                                            
G9898003004measurement period                                                                                                                                                                                                                                                                                                   
G9899001003Screening, diagnostic, film, digital or digital breast tomosynthesis (3d)       Scrn mam perf rslts doc     00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9899002004mammography results documented and reviewed                                                                                                                                                                                                                                                                          
G9900001003Screening, diagnostic, film, digital or digital breast tomosynthesis (3d)       Scrn mam perf rslts not doc 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9900002004mammography results were not documented and reviewed, reason not otherwise                                                                                                                                                                                                                                           
G9900003004specified                                                                                                                                                                                                                                                                                                            
G9901001003Patient age 65 or older in institutional special needs plans (snp) or residing  Snp/lg trm cre pt w/pos cde 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9901002004in long-term care with pos code 32, 33, 34, 54, or 56 any time during the                                                                                                                                                                                                                                            
G9901003004measurement period                                                                                                                                                                                                                                                                                                   
G9902001003Patient screened for tobacco use and identified as a tobacco user               Pt scrn tbco and id as user 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9903001003Patient screened for tobacco use and identified as a tobacco non-user           Pt scrn tbco id as non user 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9904001003Documentation of medical reason(s) for not screening for tobacco use (e.g.,     Doc med rsn no tbco scrn    00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9904002004limited life expectancy, other medical reason)                                                                                                                                                                                                                                                                       
G9905001003Patient not screened for tobacco use, reason not given                          No pt tbco scrn rng         00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9906001003Patient identified as a tobacco user received tobacco cessation intervention    Pt recv tbco cess interv    00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9906002004(counseling and/or pharmacotherapy)                                                                                                                                                                                                                                                                                  
G9907001003Documentation of medical reason(s) for not providing tobacco cessation          Doc med rsn no tbco interv  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9907002004intervention (e.g., limited life expectancy, other medical reason)                                                                                                                                                                                                                                                   
G9908001003Patient identified as tobacco user did not receive tobacco cessation            No pt tbco cess interv rng  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9908002004intervention (counseling and/or pharmacotherapy), reason not given                                                                                                                                                                                                                                                   
G9909001003Documentation of medical reason(s) for not  providing tobacco cessation         Doc med rsn no tbco interv  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9909002004intervention if identified as a tobacco user (eg, limited life expectancy,                                                                                                                                                                                                                                           
G9909003004other medical reason)                                                                                                                                                                                                                                                                                                
G9910001003Patients age 65 or older in institutional special needs plans (snp) or residing Snp/lg trm cre pt w/pos cde 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9910002004in long-term care with pos code 32, 33, 34, 54 or 56 anytime during the                                                                                                                                                                                                                                              
G9910003004measurement period                                                                                                                                                                                                                                                                                                   
G9911001003Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or    Node neg pre/post syst ther 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9911002004after neoadjuvant  systemic therapy                                                                                                                                                                                                                                                                                  
G9912001003Hepatitis b virus (hbv) status assessed and results interpreted prior to        Hbv status assesed and int  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9912002004initiating anti-tnf (tumor necrosis factor) therapy                                                                                                                                                                                                                                                                  
G9913001003Hepatitis b virus (hbv) status not assessed and results interpreted prior to    No hbv status assesd and int00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9913002004initiating anti-tnf (tumor necrosis factor) therapy, reason not given                                                                                                                                                                                                                                                
G9914001003Patient receiving an anti-tnf agent                                             Pt receiving anti-tnf agent 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9915001003No record of hbv results documented                                             No documntd hbv results rcd 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9916001003Functional status  performed once in the last 12 months                         Funct status past 12 months 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9917001003Documentation of medical reason(s) for not performing functional status (e.g.,  Doc med rsn no funct status 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9917002004patient is severely impaired and caregiver knowledge is limited, other medical                                                                                                                                                                                                                                       
G9917003004reason)                                                                                                                                                                                                                                                                                                              
G9918001003Functional status not performed, reason not otherwise specified                 No funct stat perf, rsn nos 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9919001003Screening performed and positive and provision of recommendations               Scrn nd pos nd prov of rec  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9920001003Screening performed and negative                                                Scrning perf and negative   00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9921001003No screening performed, partial screening performed or positive screen without  No or part scrn nd rng or os00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9921002004recommendations and reason is not given or otherwise specified                                                                                                                                                                                                                                                       
G9922001003Safety concerns screen provided and if positive then documented mitigation      Sfty cncrns scrn nd mit recs00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9922002004recommendations                                                                                                                                                                                                                                                                                                      
G9923001003Safety concerns screen provided and negative                                    Safty cncrns scrn and neg   00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9924001003Documentation of medical reason(s) for not providing safety concerns screen or  Doc med rsn no scrn or recs 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9924002004for not providing recommendations, orders or referrals for positive screen                                                                                                                                                                                                                                           
G9924003004(e.g., patient in palliative care, other medical reason)                                                                                                                                                                                                                                                             
G9925001003Safety concerns screening not provided, reason not otherwise specified          No scrn prov rsn nos        00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9926001003Safety concerns screening positive screen is without provision of mitigation    Sfty cncrns scrn but no recs00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9926002004recommendations, including but not limited to referral to other resources                                                                                                                                                                                                                                            
G9927001003Documentation of system reason(s) for not prescribing warfarin or another       Doc no warf /fda  pt trial  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9927002004fda-approved anticoagulation due to patient being currently enrolled in a                                                                                                                                                                                                                                            
G9927003004clinical trial related to af/atrial flutter treatment                                                                                                                                                                                                                                                                
G9928001003Warfarin or another fda-approved anticoagulant not prescribed, reason not given No warf or fda drug presc   00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9929001003Patient with transient or reversible cause of af (e.g., pneumonia,              Trs/rev af                  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9929002004hyperthyroidism, pregnancy, cardiac surgery)                                                                                                                                                                                                                                                                         
G9930001003Patients who are receiving comfort care only                                    Com care                    00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9931001003Documentation of cha2ds2-vasc risk score of 0 or 1                              No chad or chad scr 0 or 1  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9932001003Documentation of patient reason(s) for not having records of negative or        Doc pt rsn no tb scrn recrds00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9932002004managed positive tb screen (e.g., patient does not return for mantoux (ppd)                                                                                                                                                                                                                                          
G9932003004skin test evaluation)                                                                                                                                                                                                                                                                                                
G9933001003Adenoma(s) or colorectal cancer detected during screening colonoscopy           Canc detectd during col scrn00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9934001003Documentation that neoplasm detected is only diagnosed as traditional serrated  Doc rsn not detecting cancer00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9934002004adenoma, sessile serrated polyp, or sessile serrated adenoma                                                                                                                                                                                                                                                         
G9935001003Adenoma(s) or colorectal cancer not detected during screening colonoscopy       Canc not detectd during srcn00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9936001003Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or Pmh plyp/neo co/rect/jun/ans00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9936002004other malignant neoplasm of rectum, rectosigmoid junction, and anus                                                                                                                                                                                                                                                  
G9937001003Diagnostic colonoscopy                                                          Dig or surv colsco          00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9938001003Patients age 65 or older in institutional special needs plans (snp) or residing Snp/lg trm cre pt w/pos cde 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9938002004in long-term care with pos code 32, 33, 34, 54, or 56 any time during the                                                                                                                                                                                                                                            
G9938003004measurement period                                                                                                                                                                                                                                                                                                   
G9939001003Pathologists/dermatopathologists is the same clinician who performed the biopsy Same path/derm perf biopsy  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9940001003Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in     Doc reas no statin therapy  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9940002004vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease                                                                                                                                                                                                                                       
G9940003004during the measurement period or prior year)                                                                                                                                                                                                                                                                         
G9941001003Back pain was measured by the visual analog scale (vas) within three months     Pre and post vas wthn 3 mos 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9941002004preoperatively and at three months (6 - 20 weeks) postoperatively                                                                                                                                                                                                                                                    
G9942001003Patient had any additional spine procedures performed on the same date as the   Adtl spine proc on same date00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9942002004lumbar discectomy/laminotomy                                                                                                                                                                                                                                                                                         
G9943001003Back pain was not measured by the visual analog scale (vas) within three months Bk pn nt msr vas scl pre/pst00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9943002004preoperatively and at three months ( 6 - 20 weeks)  postoperatively                                                                                                                                                                                                                                                  
G9944001003Back pain was measured by the visual analog scale (vas) within three months     Vas 3 mon pre and 1 yr post 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9944002004preoperatively and at one year  (9 to 15 months) postoperatively                                                                                                                                                                                                                                                     
G9945001003Patient had cancer, fracture or infection related to the lumbar spine or        Pt w/cancer  scoliosis      00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9945002004patient had idiopathic or congenital scoliosis                                                                                                                                                                                                                                                                       
G9946001003Back pain was not measured by the visual analog scale (vas) within three months Bk pn nt msr vas pre-pst 1y 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9946002004preoperatively and at one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                                      
G9947001003Leg pain was measured by the visual analog scale (vas) within three months      Pre and post vas wthn 3 mos 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9947002004preoperatively and at three months (6 to 20 weeks) postoperatively                                                                                                                                                                                                                                                   
G9948001003Patient had any additional spine procedures performed on the same date as the   Adtl spine proc on same date00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9948002004lumbar discectomy/laminotomy                                                                                                                                                                                                                                                                                         
G9949001003Leg pain was not measured by the visual analog scale (vas) within three months  Lg pn nt msr vas scl pre/pst00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9949002004preoperatively and at three months (6 to 20 weeks) postoperatively                                                                                                                                                                                                                                                   
G9954001003Patient exhibits 2 or more risk factors for post-operative vomiting             Pt >2 rsk fac post-op vomit 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9955001003Cases in which an inhalational anesthetic is used only for induction            Inhlnt anesth only for induc00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9956001003Patient received combination therapy consisting of at least two prophylactic    Combo thrpy of >= 2 prophly 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9956002004pharmacologic anti-emetic agents of different classes preoperatively and/or                                                                                                                                                                                                                                          
G9956003004intraoperatively                                                                                                                                                                                                                                                                                                     
G9957001003Documentation of medical reason for not receiving combination therapy           Doc med rsn no combo thrpy  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9957002004consisting of at least two prophylactic pharmacologic anti-emetic agents of                                                                                                                                                                                                                                          
G9957003004different classes preoperatively and/or intraoperatively (e.g., intolerance or                                                                                                                                                                                                                                       
G9957004004other medical reason)                                                                                                                                                                                                                                                                                                
G9958001003Patient did not receive combination therapy consisting of at least two          No combo prohpyl thrp for pt00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9958002004prophylactic pharmacologic anti-emetic agents of different classes                                                                                                                                                                                                                                                   
G9958003004preoperatively and/or intraoperatively                                                                                                                                                                                                                                                                               
G9959001003Systemic antimicrobials not prescribed                                          Systemic antimicro not presc00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9960001003Documentation of medical reason(s) for prescribing systemic antimicrobials      Med rsn sys antimi nt rx    00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9961001003Systemic antimicrobials prescribed                                              Systemic antimicro presc    00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9962001003Embolization endpoints are documented separately for each embolized vessel and  Embolization doc separatly  00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9962002004ovarian artery angiography or embolization performed in the presence of variant                                                                                                                                                                                                                                      
G9962003004uterine artery anatomy                                                                                                                                                                                                                                                                                               
G9963001003Embolization endpoints are not documented separately for each embolized vessel  Embolization not doc separat00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9963002004or ovarian artery angiography or embolization not performed in the presence of                                                                                                                                                                                                                                       
G9963003004variant uterine artery anatomy                                                                                                                                                                                                                                                                                       
G9964001003Patient received at least one well-child visit with a pcp during the            Pt recv >=1 well-chld visit 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9964002004performance period                                                                                                                                                                                                                                                                                                   
G9965001003Patient did not receive at least one well-child visit with a pcp during the     No well-chld vist recv by pt00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9965002004performance period                                                                                                                                                                                                                                                                                                   
G9966001003Children who were screened for risk of developmental, behavioral and social     Scrn, inter, report child   00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9966002004delays using a standardized tool with interpretation and report                                                                                                                                                                                                                                                      
G9967001003Children who were not screened for risk of developmental, behavioral and social No scrn, inter, reprt child 00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9967002004delays using a standardized tool with interpretation and report                                                                                                                                                                                                                                                      
G9968001003Patient was referred to another provider or specialist during the performance   Pt refrd 2 pvdr/spclst in pp00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9968002004period                                                                                                                                                                                                                                                                                                               
G9969001003Provider who referred the patient to another provider received a report from    Pvdr rfrd pt rprt rcvd      00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9969002004the provider to whom the patient was referred                                                                                                                                                                                                                                                                        
G9970001003Provider who referred the patient to another provider did not receive a report  Pvdr rfrd pt no rprt rcvd   00      9                                                                                                     C                          Z2  1      02018010120180101        N                           
G9970002004from the provider to whom the patient was referred                                                                                                                                                                                                                                                                   
G9974001003Dilated macular exam performed, including documentation of the presence or      Mac exam perf               00      9                                                                                                     C                          Z2  1      02018010120190101        S                           
G9974002004absence of macular thickening or geographic atrophy or hemorrhage and the level                                                                                                                                                                                                                                      
G9974003004of macular degeneration severity                                                                                                                                                                                                                                                                                     
G9975001003Documentation of medical reason(s) for not performing a dilated macular         Doc med rsn no dil mac exam 00      9                                                                                                     C                          Z2  1      02018010120190101        S                           
G9975002004examination                                                                                                                                                                                                                                                                                                          
G9978001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 10mins    13      A                                                                                                     C                          M1A 1      02018100120181001        A                           
G9978002004only in a medicare-approved bundled payments for care improvement advanced                                                                                                                                                                                                                                           
G9978003004(bpci advanced) model episode of care, which requires these 3 key components: a                                                                                                                                                                                                                                      
G9978004004problem focused history; a problem focused examination; and straightforward                                                                                                                                                                                                                                          
G9978005004medical decision making, furnished in real time using interactive audio and                                                                                                                                                                                                                                          
G9978006004video technology.  counseling and coordination of care with other physicians,                                                                                                                                                                                                                                        
G9978007004other qualified health care professionals or agencies are provided consistent                                                                                                                                                                                                                                        
G9978008004with the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                      
G9978009004both. usually, the presenting problem(s) are self limited or minor. typically,                                                                                                                                                                                                                                       
G997801000410 minutes are spent with the patient or family or both via real time, audio                                                                                                                                                                                                                                         
G9978011004and video intercommunications technology                                                                                                                                                                                                                                                                             
G9979001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 20mins    13      A                                                                                                     C                          M1A 1      02018100120181001        A                           
G9979002004only in a medicare-approved bundled payments for care improvement advanced                                                                                                                                                                                                                                           
G9979003004(bpci advanced) model episode of care, which requires these 3 key components:                                                                                                                                                                                                                                        
G9979004004an expanded problem focused history;  an expanded problem focused examination;                                                                                                                                                                                                                                       
G9979005004straightforward medical decision making, furnished in real time using                                                                                                                                                                                                                                                
G9979006004interactive audio and video technology.  counseling and coordination of care                                                                                                                                                                                                                                         
G9979007004with other physicians, other qualified health care professionals or agencies                                                                                                                                                                                                                                         
G9979008004are provided consistent with the nature of the problem(s) and the needs of the                                                                                                                                                                                                                                       
G9979009004patient or the family or both. usually, the presenting problem(s) are of low to                                                                                                                                                                                                                                      
G9979010004moderate severity. typically, 20 minutes are spent with the patient or family                                                                                                                                                                                                                                        
G9979011004or both via real time, audio and video intercommunications technology                                                                                                                                                                                                                                                
G9980001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 30 mins   13      A                                                                                                     C                          M1A 1      02018100120181001        A                           
G9980002004only in a medicare-approved bundled payments for care improvement advanced                                                                                                                                                                                                                                           
G9980003004(bpci advanced) model episode of care, which requires these 3 key components: a                                                                                                                                                                                                                                      
G9980004004detailed history; a detailed examination; medical decision making of low                                                                                                                                                                                                                                             
G9980005004complexity, furnished in real time using interactive audio and video                                                                                                                                                                                                                                                 
G9980006004technology.  counseling and coordination of care with other physicians, other                                                                                                                                                                                                                                        
G9980007004qualified health care professionals or agencies are provided consistent with                                                                                                                                                                                                                                         
G9980008004the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                           
G9980009004both. usually, the presenting  problem(s) are of moderate severity. typically,                                                                                                                                                                                                                                       
G998001000430 minutes are spent with the patient or family or both via real time, audio                                                                                                                                                                                                                                         
G9980011004and video intercommunications technology                                                                                                                                                                                                                                                                             
G9981001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 45mins    13      A                                                                                                     C                          M1A 1      02018100120181001        A                           
G9981002004only in a medicare-approved bundled payments for care improvement advanced                                                                                                                                                                                                                                           
G9981003004(bpci advanced) model episode of care, which requires these 3 key components: a                                                                                                                                                                                                                                      
G9981004004comprehensive history; a comprehensive examination; medical decision making of                                                                                                                                                                                                                                       
G9981005004moderate complexity, furnished in real time using interactive audio and video                                                                                                                                                                                                                                        
G9981006004technology.  counseling and coordination of care with other physicians, other                                                                                                                                                                                                                                        
G9981007004qualified health care professionals or agencies are provided consistent with                                                                                                                                                                                                                                         
G9981008004the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                           
G9981009004both. usually, the presenting problem(s) are of moderate to high severity.                                                                                                                                                                                                                                           
G9981010004typically, 45 minutes are spent with the patient or family or both via real                                                                                                                                                                                                                                          
G9981011004time, audio and video intercommunications technology                                                                                                                                                                                                                                                                 
G9982001003Remote in-home visit for the evaluation and management of a new patient for use Remote e/m new pt 60mins    13      A                                                                                                     C                          M1A 1      02018100120181001        A                           
G9982002004only in a medicare-approved bundled payments for care improvement advanced                                                                                                                                                                                                                                           
G9982003004(bpci advanced) model episode of care, which requires these 3 key components: a                                                                                                                                                                                                                                      
G9982004004comprehensive history; a comprehensive examination; medical decision making of                                                                                                                                                                                                                                       
G9982005004high complexity, furnished in real time using interactive audio and video                                                                                                                                                                                                                                            
G9982006004technology.  counseling and coordination of care with other physicians, other                                                                                                                                                                                                                                        
G9982007004qualified health care professionals or agencies are provided consistent with                                                                                                                                                                                                                                         
G9982008004the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                           
G9982009004both. usually, the presenting problem(s) are of moderate to high severity.                                                                                                                                                                                                                                           
G9982010004typically, 60 minutes are spent with the patient or family or both via real                                                                                                                                                                                                                                          
G9982011004time, audio and video intercommunications technology                                                                                                                                                                                                                                                                 
G9983001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 10mins   13      A                                                                                                     C                          M1B 1      02018100120181001        A                           
G9983002004patient for use only in a medicare-approved bundled payments for care                                                                                                                                                                                                                                                
G9983003004improvement advanced (bpci advanced) model episode of care, which requires at                                                                                                                                                                                                                                        
G9983004004least 2 of the following 3 key components: a problem focused history; a problem                                                                                                                                                                                                                                      
G9983005004focused examination; straightforward medical decision making, furnished in real                                                                                                                                                                                                                                      
G9983006004time using interactive audio and video technology. counseling and coordination                                                                                                                                                                                                                                       
G9983007004of care with other physicians, other qualified health care professionals or                                                                                                                                                                                                                                          
G9983008004agencies are provided consistent with the nature of the problem(s) and the                                                                                                                                                                                                                                           
G9983009004needs of the patient or the family or both. usually, the presenting problem(s)                                                                                                                                                                                                                                       
G9983010004are self limited or minor. typically, 10 minutes are spent with the patient or                                                                                                                                                                                                                                       
G9983011004family or both via real time, audio and video intercommunications technology                                                                                                                                                                                                                                         
G9984001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt  15mins  13      A                                                                                                     C                          M1B 1      02018100120181001        A                           
G9984002004patient for use only in a medicare-approved bundled payments for care                                                                                                                                                                                                                                                
G9984003004improvement advanced (bpci advanced) model episode of care, which requires at                                                                                                                                                                                                                                        
G9984004004least 2 of the following 3 key components: an expanded problem focused history;                                                                                                                                                                                                                                      
G9984005004an expanded problem focused examination; medical decision making of low                                                                                                                                                                                                                                              
G9984006004complexity, furnished in real time using interactive audio and video                                                                                                                                                                                                                                                 
G9984007004technology.  counseling and coordination of care with other physicians, other                                                                                                                                                                                                                                        
G9984008004qualified health care professionals or agencies are provided consistent with                                                                                                                                                                                                                                         
G9984009004the nature of the problem(s) and the needs of the patient or the family or                                                                                                                                                                                                                                           
G9984010004both. usually, the presenting problem(s) are of low to moderate severity.                                                                                                                                                                                                                                            
G9984011004typically, 15 minutes are spent with the patient or family or both via real                                                                                                                                                                                                                                          
G9984012004time, audio and video intercommunications technology                                                                                                                                                                                                                                                                 
G9985001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 25mins   13      A                                                                                                     C                          M1B 1      02018100120181001        A                           
G9985002004patient for use only in a medicare-approved bundled payments for care                                                                                                                                                                                                                                                
G9985003004improvement advanced (bpci advanced) model episode of care, which requires at                                                                                                                                                                                                                                        
G9985004004least 2 of the following 3 key components: a detailed history;  a detailed                                                                                                                                                                                                                                           
G9985005004examination; medical decision making of moderate complexity, furnished in real                                                                                                                                                                                                                                       
G9985006004time using interactive audio and video technology.  counseling and coordination                                                                                                                                                                                                                                      
G9985007004of care with other physicians, other qualified health care professionals or                                                                                                                                                                                                                                          
G9985008004agencies are provided consistent with the nature of the problem(s) and the                                                                                                                                                                                                                                           
G9985009004needs of the patient or the family or both. usually, the presenting problem(s)                                                                                                                                                                                                                                       
G9985010004are of moderate to high severity. typically, 25 minutes are spent with the                                                                                                                                                                                                                                           
G9985011004patient or family or both via real time, audio and video intercommunications                                                                                                                                                                                                                                         
G9985012004technology                                                                                                                                                                                                                                                                                                           
G9986001003Remote in-home visit for the evaluation and management of an established        Remote e/m est. pt 40mins   13      A                                                                                                     C                          M1B 1      02018100120181001        A                           
G9986002004patient for use only in a medicare-approved bundled payments for care                                                                                                                                                                                                                                                
G9986003004improvement advanced (bpci advanced) model episode of care, which requires at                                                                                                                                                                                                                                        
G9986004004least 2 of the following 3 key components: a comprehensive history; a                                                                                                                                                                                                                                                
G9986005004comprehensive examination; medical decision making of high complexity,                                                                                                                                                                                                                                               
G9986006004furnished in real time using interactive audio and video technology.                                                                                                                                                                                                                                                 
G9986007004counseling and coordination of care with other physicians, other qualified                                                                                                                                                                                                                                           
G9986008004health care professionals or agencies are provided consistent with the nature                                                                                                                                                                                                                                        
G9986009004of the problem(s) and the needs of the patient or the family or both. usually,                                                                                                                                                                                                                                       
G9986010004the presenting problem(s) are of moderate to high severity. typically, 40                                                                                                                                                                                                                                            
G9986011004minutes are spent with the patient or family or both via real time, audio and                                                                                                                                                                                                                                        
G9986012004video intercommunications technology                                                                                                                                                                                                                                                                                 
G9987001003Bundled payments for care improvement advanced (bpci advanced) model home visit Bpci advanced in home visit 13      A                                                                                                     C                          M5D 1      02018100120181001        A                           
G9987002004for patient assessment performed by clinical staff for an individual not                                                                                                                                                                                                                                             
G9987003004considered homebound, including, but not necessarily limited to patient                                                                                                                                                                                                                                              
G9987004004assessment of clinical status, safety/fall prevention, functional                                                                                                                                                                                                                                                    
G9987005004status/ambulation, medication reconciliation/management, compliance with                                                                                                                                                                                                                                             
G9987006004orders/plan of care, performance of activities of daily living, and ensuring                                                                                                                                                                                                                                         
G9987007004beneficiary  connections to community and other services; for use only for a                                                                                                                                                                                                                                         
G9987008004bpci advanced model episode of care; may not be billed for a 30-day period                                                                                                                                                                                                                                           
G9987009004covered by a transitional care management code                                                                                                                                                                                                                                                                       
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                                                                                                                                                                                                                                                                                                     
H0049001003Alcohol and/or drug screening                                                   Alcohol/drug screening      00      9                                                                                                     I                          Z2  9      02007010120070101        N                           
H0050001003Alcohol and/or drug services, brief intervention, per 15 minutes                Alcohol/drug service 15 min 00      9                                                                                                     I                          Z2  9      02007010120070101        N                           
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     01986010120180101        N                           
J0129001003Injection, abatacept, 10 mg (code may be used for medicare when drug            Abatacept injection         51      A                                                                                                     CYY20080101                O1E 1P     02007010120120101        N                           
J0129002004administered under the direct supervision of a physician, not for use when drug                                                                                                                                                                                                                                      
J0129003004is self administered)                                                                                                                                                                                                                                                                                                
J0130001003Injection abciximab, 10 mg                                                      Abciximab injection         51      A                  2049                                                                               D                          O1E 1P     01999010120180101        N                           
J0131001003Injection, acetaminophen, 10 mg                                                 Acetaminophen injection     51      A                                                                                                     C                          O1E 1P     02012010120140101        N                           
J0132001003Injection, acetylcysteine, 100 mg                                               Acetylcysteine injection    51      A                                                                                                     C                          O1E 1P     02006010120180101        N                           
J0133001003Injection, acyclovir, 5 mg                                                      Acyclovir injection         51      A                                                                                                     C                          O1E 1P     02006010120060101        N                           
J0135001003Injection, adalimumab, 20 mg                                                    Adalimumab injection        51      A                                                                                                     CYY20080101                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     0199401012015010120141231N                           
J0150002004adenosine phosphate compounds, instead use a9270)                                                                                                                                                                                                                                                                    
J0151001003Injection, adenosine for diagnostic use, 1 mg (not to be used to report any     Inj adenosine diag 1mg      51      A                                                                                                     C                          O1E 1P     0201401012015010120141231N                           
J0151002004adenosine phosphate compounds, instead use a9270)                                                                                                                                                                                                                                                                    
J0153001003Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate    Adenosine inj 1mg           51      A                                                                                                     D                      0194O1E 1P     02015010120150101        N                           
J0153002004compounds)                                                                                                                                                                                                                                                                                                           
J0171001003Injection, adrenalin, epinephrine, 0.1 mg                                       Adrenalin epinephrine inject51      A                  2049                                                                               D                          O1E 1P     02011010120110101        N                           
J0178001003Injection, aflibercept, 1 mg                                                    Aflibercept injection       51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        N                           
J0180001003Injection, agalsidase beta, 1 mg                                                Agalsidase beta injection   51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J0185001003Injection, aprepitant, 1 mg                                                     Inj., aprepitant, 1 mg      51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
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     02000010120160101        N                           
J0202001003Injection, alemtuzumab, 1 mg                                                    Injection, alemtuzumab      51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
J0205001003Injection, alglucerase, per 10 units                                            Alglucerase injection       51      A                  2049                                                                               D                          O1E 1P     01993010119970101        N                           
J0207001003Injection, amifostine, 500 mg                                                   Amifostine                  51      A                  2049                                                                               DYY20080101                O1D 1P     01998010119980101        N                           
J0210001003Injection, methyldopate hcl, up to 250 mg                                       Methyldopate hcl injection  51      A                  2049                                                                               D                          O1E 1P     01984010120140101        N                           
J0215001003Injection, alefacept, 0.5 mg                                                    Alefacept                   51      A                                                                                                     C                          O1E 1G     02004010120180101        N                           
J0220001003Injection, alglucosidase alfa, 10 mg, not otherwise specified                   Alglucosidase alfa injection51      A                                                                                                     CYY20080101                O1E 1P     02008010120120101        N                           
J0221001003Injection, alglucosidase alfa, (lumizyme), 10 mg                                Lumizyme injection          51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
J0256001003Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg Alpha 1 proteinase inhibitor51      A                  2049                                                                               DYY20080101                O1E 1P     01989010120120101        N                           
J0257001003Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg               Glassia injection           51      A                  2049                                                                               DYY20120101                O1E 1P     02012010120120101        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        N                           
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                           
J0287001003Injection, amphotericin b lipid complex, 10 mg                                  Amphotericin b lipid complex51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N                           
J0288001003Injection, amphotericin b cholesteryl sulfate complex, 10 mg                    Ampho b cholesteryl sulfate 51      A                  2049                                                                               D                          O1E 1P     02003010120140101        N                           
J0289001003Injection, amphotericin b liposome, 10 mg                                       Amphotericin b liposome inj 51      A                  2049                                                                               DYY20080101                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 sulbactam 1.5 gm 51      A                  2049                                                                               D                          O1E 1P     01995010120190101        S                           
J0300001003Injection, amobarbital, up to 125 mg                                            Amobarbital 125 mg inj      51      A                  2049                                                                               DYY20120101                O1E 1P     01982010119970101        N                           
J0330001003Injection, succinylcholine chloride, up to 20 mg                                Succinycholine chloride inj 51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J0348001003Injection, anidulafungin, 1 mg                                                  Anidulafungin injection     51      A                                                                                                     C                          O1E 1P     02007010120140101        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                           
J0364001003Injection, apomorphine hydrochloride, 1 mg                                      Apomorphine hydrochloride   51      A                                                                                                     C                          O1E 1P     02007010120070101        N                           
J0365001003Injection, aprotonin, 10,000 kiu                                                Aprotonin, 10,000 kiu       51      A                  2049                                                                               D                      0095O1E 1P     02006010120180101        N                           
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     01999010120140101        N                           
J0400001003Injection, aripiprazole, intramuscular, 0.25 mg                                 Aripiprazole injection      51      A                                                                                                     C                          O1E 1P     02008010120190101        P                           
J0401001003Injection, aripiprazole, extended release, 1 mg                                 Inj aripiprazole ext rel 1mg51      A                                                                                                     CYY20140101                O1E 1P     02014010120140101        N                           
J0456001003Injection, azithromycin, 500 mg                                                 Azithromycin                51      A                  2049.5                                                                             D                          O1E 1P     02000010120000101        N                           
J0461001003Injection, atropine sulfate, 0.01 mg                                            Atropine sulfate injection  51      A                  2049                                                                               D                          O1E 1P     02010010120100101        N                           
J0470001003Injection, dimercaprol, per 100 mg                                              Dimecaprol injection        51      A                  2049                                                                               D                          O1E 1P     01982010120190101        P                           
J0475001003Injection, baclofen, 10 mg                                                      Baclofen 10 mg injection    51      A                  2049                                                                               DYY20080101                O1E 1P     01994010119970101        N                           
J0476001003Injection, baclofen, 50 mcg for intrathecal trial                               Baclofen intrathecal trial  51      A                  2049                                                                               D                          O1E 1P     01999010120190101        P                           
J0480001003Injection, basiliximab, 20 mg                                                   Basiliximab                 51      A                  2049                                                                               DYY20080101            0095O1E 1G     02006010120060101        N                           
J0485001003Injection, belatacept, 1 mg                                                     Belatacept injection        51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        N                           
J0490001003Injection, belimumab, 10 mg                                                     Belimumab injection         51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
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                           
J0517001003Injection, benralizumab, 1 mg                                                   Inj., benralizumab, 1 mg    51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J0520001003Injection, bethanechol chloride, myotonachol or urecholine, up to 5 mg          Bethanechol chloride inject 51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J0558001003Injection, penicillin g benzathine and penicillin g procaine, 100,000 units     Peng benzathine/procaine inj51      A                                                                                                     CYY20190101                O1E 1P     02011010120190101        P                           
J0561001003Injection, penicillin g benzathine, 100,000 units                               Penicillin g benzathine inj 51      A                  2049                                                                               DYY20160101                O1E 1P     02011010120160101        N                           
J0565001003Injection, bezlotoxumab, 10 mg                                                  Inj, bezlotoxumab, 10 mg    51      A                                                                                                     CYY20180101                O1E 1P     02018010120180101        N                           
J0567001003Injection, cerliponase alfa, 1 mg                                               Inj., cerliponase alfa 1 mg 51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J0570001003Buprenorphine implant, 74.2 mg                                                  Buprenorphine implant 74.2mg51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J0571001003Buprenorphine, oral, 1 mg                                                       Buprenorphine oral 1mg      00      9                                                                                                     D                      0127O1E 1P     02015010120150101        N                           
J0572001003Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine          Bupren/nal up to 3mg bupreno00      9                                                                                                     D                      0127O1E 1P     02015010120160101        N                           
J0573001003Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg Bupren/nal 3.1 to 6mg bupren00      9                                                                                                     D                      0127O1E 1P     02015010120170101        N                           
J0573002004buprenorphine                                                                                                                                                                                                                                                                                                        
J0574001003Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10   Bupren/nal 6.1 to 10mg bupre00      9                                                                                                     D                      0127O1E 1P     02015010120160101        N                           
J0574002004mg buprenorphine                                                                                                                                                                                                                                                                                                     
J0575001003Buprenorphine/naloxone, oral, greater than 10 mg buprenorphine                  Bupren/nal over 10mg bupreno00      9                                                                                                     D                      0127O1E 1P     02015010120160101        N                           
J0583001003Injection, bivalirudin, 1 mg                                                    Bivalirudin                 51      A                                                                                                     C                          O1E 1P     02004010120180101        N                           
J0584001003Injection, burosumab-twza 1 mg                                                  Injection, burosumab-twza 1m51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J0585001003Injection, onabotulinumtoxina, 1 unit                                           Injection,onabotulinumtoxina51      A                  2049                                                                               DYY20080101                O1E 1P     01991010120100101        N                           
J0586001003Injection, abobotulinumtoxina, 5 units                                          Abobotulinumtoxina          51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N                           
J0587001003Injection, rimabotulinumtoxinb, 100 units                                       Inj, rimabotulinumtoxinb    51      A                  2049                                                                               DYY20080101                O1E 1P     02002010120100101        N                           
J0588001003Injection, incobotulinumtoxin a, 1 unit                                         Incobotulinumtoxin a        51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
J0592001003Injection, buprenorphine hydrochloride, 0.1 mg                                  Buprenorphine hydrochloride 51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J0594001003injection, busulfan, 1 mg                                                       Busulfan injection          51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J0595001003Injection, butorphanol tartrate, 1 mg                                           Butorphanol tartrate 1 mg   51      A                                                                                                     C                          O1E 1      02004010120040101        N                           
J0596001003Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units              Injection, ruconest         51      A                                                                                                     CYY20160101                O1E 1      02016010120160101        N                           
J0597001003Injection, c-1 esterase inhibitor (human), berinert, 10 units                   C-1 esterase, berinert      51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J0598001003Injection, c-1 esterase inhibitor (human), cinryze, 10 units                    C-1 esterase, cinryze       51      A                                                                                                     CYY20100101                O1E 1P     02010010120110101        N                           
J0599001003Injection, c-1 esterase inhibitor (human), (haegarda), 10 units                 Inj., haegarda 10 units     51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J0600001003Injection, edetate calcium disodium, up to 1000 mg                              Edetate calcium disodium inj51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N                           
J0604001003Cinacalcet, oral, 1 mg, (for esrd on dialysis)                                  Cinacalcet, esrd on dialysis51      A                                                                                                     D                      0195O1E 1L     02018010120180101        N                           
J0606001003Injection, etelcalcetide, 0.1 mg                                                Inj, etelcalcetide, 0.1 mg  51      A                                                                                                     DYY20180101            0195O1E 1L     02018010120180101        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                                                                               DYY20130101                O1E 1P     01982010119970101        N                           
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                                                                                                     CYY20080101                O1E 1P     02003010120030101        N                           
J0638001003Injection, canakinumab, 1 mg                                                    Canakinumab injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J0640001003Injection, leucovorin calcium, per 50 mg                                        Leucovorin calcium injection51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0641001003Injection, levoleucovorin calcium, 0.5 mg                                       Levoleucovorin injection    51      A                                                                                                     DYY20090101            0127O1E 1P     02009010120090101        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                           
J0695001003Injection, ceftolozane 50 mg and tazobactam 25 mg                               Inj ceftolozane tazobactam  51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        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 3 mg and betamethasone sodium phosphate 3 mg   Betamethasone acet&sod phosp51      A                  2049                                                                               D                          O1E 1P     01995010120080101        N                           
J0706001003Injection, caffeine citrate, 5 mg                                               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                           
J0712001003Injection, ceftaroline fosamil, 10 mg                                           Ceftaroline fosamil inj     51      A                                                                                                     CYY20160101                O1E 1P     02012010120160101        N                           
J0713001003Injection, ceftazidime, per 500 mg                                              Inj ceftazidime per 500 mg  51      A                  2049                                                                               D                          O1E 1P     01996010119970101        N                           
J0714001003Injection, ceftazidime and avibactam, 0.5 g/0.125 g                             Ceftazidime and avibactam   51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
J0715001003Injection, ceftizoxime sodium, per 500 mg                                       Ceftizoxime sodium / 500 mg 51      A                  2049                                                                               D                          O1E 1P     01995010119970101        N                           
J0716001003Injection, centruroides immune f(ab)2, up to 120 milligrams                     Centruroides immune f(ab)   51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        N                           
J0717001003Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug    Certolizumab pegol inj 1mg  51      A                                                                                                     CYY20140101                O1E 1P     02014010120140101        N                           
J0717002004administered under the direct supervision of a physician, not for use when drug                                                                                                                                                                                                                                      
J0717003004is self administered)                                                                                                                                                                                                                                                                                                
J0720001003Injection, chloramphenicol sodium succinate, up to 1 gm                         Chloramphenicol sodium injec51      A                  2049                                                                               D                          O1E 1P     01982010120180101        N                           
J0725001003Injection, chorionic gonadotropin, per 1,000 usp units                          Chorionic gonadotropin/1000u51      A                  2049                                                                               DYY20190101                O1E 1P     01986010120190101        P                           
J0735001003Injection, clonidine hydrochloride, 1 mg                                        Clonidine hydrochloride     51      A                  2049                                                                               D                          O1E 1P     01998010119980101        N                           
J0740001003Injection, cidofovir, 375 mg                                                    Cidofovir injection         51      A                  2049                                                                               DYY20080101                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 1 mg                                                 Colchicine injection        51      A                  2049                                                                               D                          O1E 1P     0198201012017010120161231N                           
J0770001003Injection, colistimethate sodium, up to 150 mg                                  Colistimethate sodium inj   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J0775001003Injection, collagenase, clostridium histolyticum, 0.01 mg                       Collagenase, clost hist inj 51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        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                                                                               DYY20080101            0095O1E 1P     02006010120060101        N                           
J0800001003Injection, corticotropin, up to 40 units                                        Corticotropin injection     51      A                  2049                                                                               D                          O1E 1P     01982010120190101        P                           
J0833001003Injection, cosyntropin, not otherwise specified, 0.25 mg                        Cosyntropin injection nos   51      A                                                                                                     C                          O1E 1P     0201001012019010120181231D                           
J0834001003Injection, cosyntropin, 0.25 mg                                                 Inj., cosyntropin, 0.25 mg  51      A                                                                                                     C                          O1E 1P     02010010120190101        C                           
J0840001003Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram               Crotalidae poly immune fab  51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
J0841001003Injection, crotalidae immune f(ab')2 (equine), 120 mg                           Inj crotalidae im f(ab')2 eq51      A                                                                                                     CYY20190101                O1E 1P     02019010120190101        A                           
J0850001003Injection, cytomegalovirus immune globulin intravenous (human), per vial        Cytomegalovirus imm iv /vial51      A                  2049                                                                               DYY20080101                O1E 1P     01982010119970101        N                           
J0875001003Injection, dalbavancin, 5 mg                                                    Injection, dalbavancin      51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
J0878001003Injection, daptomycin, 1 mg                                                     Daptomycin injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J0881001003Injection, darbepoetin alfa, 1 microgram (non-esrd use)                         Darbepoetin alfa, non-esrd  51      A                                                                                                     DYY20080101            0132O1E 1L     02006010120060101        N                           
J0882001003Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)                 Darbepoetin alfa, esrd use  57      A                  4273.1                                                                             DYY20170101                O1E 1L     02006010120170101        N                           
J0883001003Injection, argatroban, 1 mg (for non-esrd use)                                  Argatroban nonesrd use 1mg  51      A                  2049    4273.1                                                                     DYY20170101                O1E 9      02017010120170101        N                           
J0884001003Injection, argatroban, 1 mg (for esrd on dialysis)                              Argatroban esrd dialysis 1mg51      A                  2049    4273.1                                                                     DYY20180101                O1E 1L     02017010120180101        N                           
J0885001003Injection, epoetin alfa, (for non-esrd use), 1000 units                         Epoetin alfa, non-esrd      51      A                  2049                                                                               DYY20080101                O1E 9      02006010120060101        N                           
J0886001003Injection, epoetin alfa, 1000 units (for esrd on dialysis)                      Epoetin alfa 1000 units esrd57      A                  4273.1                                                                             D                          O1E 1L     0200601012016010120151231N                           
J0887001003Injection, epoetin beta, 1 microgram, (for esrd on dialysis)                    Epoetin beta esrd use       57      A                                                                                                     D                      0195O1E 1L     02015010120150101        N                           
J0888001003Injection, epoetin beta, 1 microgram, (for non esrd use)                        Epoetin beta non esrd       57      A                                                                                                     D                      0195O1E 9      02015010120190101        P                           
J0890001003Injection, peginesatide, 0.1 mg (for esrd on dialysis)                          Peginesatide injection      51      A                                                                                                     C                          O1E 1P     02013010120130101        N                           
J0894001003Injection, decitabine, 1 mg                                                     Decitabine injection        51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J0895001003Injection, deferoxamine mesylate, 500 mg                                        Deferoxamine mesylate inj   51      A                  2049                                                      Q0087                    D                          O1E 1P     01992010120010101        N                           
J0897001003Injection, denosumab, 1 mg                                                      Denosumab injection         51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
J0900001003Injection, testosterone enanthate and estradiol valerate, up to 1 cc            Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
J0945001003Injection, brompheniramine maleate, per 10 mg                                   Brompheniramine maleate inj 51      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, 1 mg                                    Medroxyprogesterone acetate 51      A                                                                                                     C                          O1E 1P     02013010120130101        N                           
J1060001003Injection, testosterone cypionate and estradiol cypionate, up to 1 ml           Testosterone cypionate 1 ml 51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
J1070001003Injection, testosterone cypionate, up to 100 mg                                 Testosterone cypionat 100 mg51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
J1071001003Injection, testosterone cypionate, 1 mg                                         Inj testosterone cypionate  51      A                                                                                                     D                      0194O1E 1P     02015010120150101        N                           
J1080001003Injection, testosterone cypionate, 1 cc, 200 mg                                 Testosterone cypionat 200 mg51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
J1094001003Injection, dexamethasone acetate, 1 mg                                          Inj dexamethasone acetate   51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J1100001003Injection, dexamethasone sodium phosphate, 1 mg                                 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     01982010120190101        P                           
J1120001003Injection, acetazolamide sodium, up to 500 mg                                   Acetazolamid sodium injectio51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1130001003Injection, diclofenac sodium, 0.5 mg                                            Inj diclofenac sodium 0.5mg 51      A                                                                                                     C                          O1E 1      02017010120190101        P                           
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                                                                               DYY20080101            0095O1E 1P     02006010120060101        N                           
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                                                                               DYY20080101                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     01982010120180101        N                           
J1212001003Injection, dmso, dimethyl sulfoxide, 50%, 50 ml                                 Dimethyl sulfoxide 50% 50 ml51      A45-23             2049                                                                               DYY20170101                O1E 1P     01986010120170101        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        N                           
J1267001003Injection, doripenem, 10 mg                                                     Doripenem injection         51      A                                                                                                     C                          O1E 1P     02009010120090101        N                           
J1270001003Injection, doxercalciferol, 1 mcg                                               Injection, doxercalciferol  51      A                                                                                                     C                          O1E 1P     02002010120020101        N                           
J1290001003Injection, ecallantide, 1 mg                                                    Ecallantide injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J1300001003Injection, eculizumab, 10 mg                                                    Eculizumab injection        51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N                           
J1301001003Injection, edaravone, 1 mg                                                      Injection, edaravone, 1 mg  51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J1320001003Injection, amitriptyline hcl, up to 20 mg                                       Amitriptyline injection     51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1322001003Injection, elosulfase alfa, 1 mg                                                Elosulfase alfa, injection  51      A                                                                                                     CYY20150101                O1E 1P     02015010120150101        N                           
J1324001003Injection, enfuvirtide, 1 mg                                                    Enfuvirtide injection       51      A                                                                                                     C                          O1E 1P     02007010120180101        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                                                                               DYY20080101                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                                                                               DYY20170101                O1E 1P     01995010120170101        N                           
J1380001003Injection, estradiol valerate, up to 10 mg                                      Estradiol valerate 10 mg inj51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1410001003Injection, estrogen conjugated, per 25 mg                                       Inj estrogen conjugate 25 mg51      A                  2049                                                                               DYY20170101                O1E 1P     01982010120170101        N                           
J1428001003Injection, eteplirsen, 10 mg                                                    Inj, eteplirsen, 10 mg      51      A                                                                                                     CYY20180101                O1E 1P     02018010120180101        N                           
J1430001003Injection, ethanolamine oleate, 100 mg                                          Ethanolamine oleate 100 mg  51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N                           
J1435001003Injection, estrone, per 1 mg                                                    Injection estrone per 1 mg  51      A                  2049                                                                               D                          O1E 1P     01982010120140101        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                                                                               DYY20080101                O1E 1P     02000010120000101        N                           
J1438002004administered under the direct supervision of a physician, not for use when drug                                                                                                                                                                                                                                      
J1438003004is self administered)                                                                                                                                                                                                                                                                                                
J1439001003Injection, ferric carboxymaltose, 1 mg                                          Inj ferric carboxymaltos 1mg51      A                                                                                                     CYY20150101                O1E 1P     02015010120150101        N                           
J1442001003Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram                Inj filgrastim excl biosimil51      A                                                                                                     DYY20140101            0187O1E 1P     02014010120160101        N                           
J1443001003Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron                Inj ferric pyrophosphate cit51      A                                                                                                     C                          O1E 1L     02016010120160101        N                           
J1446001003Injection, tbo-filgrastim, 5 micrograms                                         Inj, tbo-filgrastim, 5 mcg  51      A                                                                                                     D                      0187O1E 1P     0201401012016010120151231N                           
J1447001003Injection, tbo-filgrastim, 1 microgram                                          Inj tbo filgrastim 1 microg 51      A                  2049.5                                                                             DYY20160101                O1E 1P     02016010120160101        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                                                                               DYY20080101            0095O1E 1P     02006010120060101        N                           
J1452001003Injection, fomivirsen sodium, intraocular, 1.65 mg                              Intraocular fomivirsen na   51      A                  2049.3                                                                             D                          O1E 1P     02001010120140101        N                           
J1453001003Injection, fosaprepitant, 1 mg                                                  Fosaprepitant injection     51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N                           
J1454001003Injection, fosnetupitant 235 mg and palonosetron 0.25 mg                        Inj fosnetupitant, palonoset51      A                                                                                                     DYY20190101            0204O1E 1      02019010120190101        A                           
J1455001003Injection, foscarnet sodium, per 1000 mg                                        Foscarnet sodium injection  51      A                  2049                                                                               DYY20170101                O1E 1P     01993010120170101        N                           
J1457001003Injection, gallium nitrate, 1 mg                                                Gallium nitrate injection   51      A                                                                                                     C                          O1E 1P     02005010120050101        N                           
J1458001003Injection, galsulfase, 1 mg                                                     Galsulfase injection        51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J1459001003Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g.,      Inj ivig privigen 500 mg    51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        N                           
J1459002004liquid), 500 mg                                                                                                                                                                                                                                                                                                      
J1460001003Injection, gamma globulin, intramuscular, 1 cc                                  Gamma globulin 1 cc inj     51      A                  2049                                                                               DYY20170101                O1E 1P     01984010120170101        N                           
J1555001003Injection, immune globulin (cuvitru), 100 mg                                    Inj cuvitru, 100 mg         51      A                                                                                                     CYY20180101                D1G 1P     02018010120180101        N                           
J1556001003Injection, immune globulin (bivigam), 500 mg                                    Inj, imm glob bivigam, 500mg51      A                                                                                                     CYY20140101                O1E 1P     02014010120140101        N                           
J1557001003Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g.,    Gammaplex injection         51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
J1557002004liquid), 500 mg                                                                                                                                                                                                                                                                                                      
J1559001003Injection, immune globulin (hizentra), 100 mg                                   Hizentra injection          51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J1560001003Injection, gamma globulin, intramuscular, over 10 cc                            Gamma globulin > 10 cc inj  51      A                  2049                                                                               DYY20170101                O1E 1P     01984010120170101        N                           
J1561001003Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g.,        Gamunex-c/gammaked          51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120130101        N                           
J1561002004liquid), 500 mg                                                                                                                                                                                                                                                                                                      
J1562001003Injection, immune globulin (vivaglobin), 100 mg                                 Vivaglobin, inj             51      A                                                                                                     C                          O1E 1P     02007010120080101        N                           
J1566001003Injection, immune globulin, intravenous, lyophilized (e.g., powder), not        Immune globulin, powder     51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120080101        N                           
J1566002004otherwise specified, 500 mg                                                                                                                                                                                                                                                                                          
J1568001003Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g.,      Octagam injection           51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N                           
J1568002004liquid), 500 mg                                                                                                                                                                                                                                                                                                      
J1569001003Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g.,         Gammagard liquid injection  51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120130101        N                           
J1569002004liquid), 500 mg                                                                                                                                                                                                                                                                                                      
J1570001003Injection, ganciclovir sodium, 500 mg                                           Ganciclovir sodium injection51      A                  2049                                                                               D                          O1E 1P     01994010119970101        N                           
J1571001003Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml       Hepagam b im injection      51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120090101        N                           
J1572001003Injection, immune globulin, (flebogamma/flebogamma dif), intravenous,           Flebogamma injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02008010120090101        N                           
J1572002004non-lyophilized (e.g., liquid), 500 mg                                                                                                                                                                                                                                                                               
J1573001003Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml         Hepagam b intravenous, inj  51      A                                                                                                     CYY20080101                O1E 1P     02008010120090101        N                           
J1575001003Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin       Hyqvia 100mg immuneglobulin 51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
J1580001003Injection, garamycin, gentamicin, up to 80 mg                                   Garamycin gentamicin inj    51      A                  2049                                                                               D                          O1E 1P     01984010119970101        N                           
J1590001003Injection, gatifloxacin, 10 mg                                                  Gatifloxacin injection      51      A                                                                                                     C                          O1E 1P     0200201012017010120161231N                           
J1595001003Injection, glatiramer acetate, 20 mg                                            Injection glatiramer acetate51      A                  2049                                                                               DYY20080101                O1E 1P     02004010120040101        N                           
J1599001003Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not    Ivig non-lyophilized, nos   51      A                                                                                                     C                          O1E 1P     02011010120110101        N                           
J1599002004otherwise specified, 500 mg                                                                                                                                                                                                                                                                                          
J1600001003Injection, gold sodium thiomalate, up to 50 mg                                  Gold sodium thiomaleate inj 51      A                  2049                                                                               D                          O1E 1P     01982010120160101        N                           
J1602001003Injection, golimumab, 1 mg, for intravenous use                                 Golimumab for iv use 1mg    51      A                                                                                                     CYY20140101                O1E 1P     02014010120140101        N                           
J1610001003Injection, glucagon hydrochloride, per 1 mg                                     Glucagon hydrochloride/1 mg 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119970101        N                           
J1620001003Injection, gonadorelin hydrochloride, per 100 mcg                               Gonadorelin hydroch/ 100 mcg51      A                  2049                                                                               D                          O1E 1P     01982010120140101        N                           
J1626001003Injection, granisetron hydrochloride, 100 mcg                                   Granisetron hcl injection   51      A                  2049                                                                               D                          O1E 1P     01998010120090101        N                           
J1627001003Injection, granisetron, extended-release, 0.1 mg                                Inj, granisetron, xr, 0.1 mg51      A                                                                                                     CYY20180101                O1E 1P     02018010120180101        N                           
J1628001003Injection, guselkumab, 1 mg                                                     Inj., guselkumab, 1 mg      51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
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                                                                               DYY20080101            0095O1E 1P     02006010120060101        N                           
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                                                                               DYY20080101                O1E 1P     01986010119970101        N                           
J1675001003Injection, histrelin acetate, 10 micrograms                                     Histrelin acetate           51      A                  2049                                                                               D                      0095O1E 1G     02006010120060101        N                           
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                           
J1725001003Injection, hydroxyprogesterone caproate, 1 mg                                   Hydroxyprogesterone caproate00      9                                                                                                     IYY20120101                O1E 1P     0201201012018010120171231N                           
J1726001003Injection, hydroxyprogesterone caproate, (makena), 10 mg                        Makena, 10 mg               51      A                                                                                                     CYY20180101                O1E 1P     02018010120180101        N                           
J1729001003Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg         Inj hydroxyprogst capoat nos51      A                                                                                                     C                          O1E 1P     02018010120180101        N                           
J1730001003Injection, diazoxide, up to 300 mg                                              Diazoxide injection         51      A                  2049                                                                               D                          O1E 1P     01982010120180101        N                           
J1740001003Injection, ibandronate sodium, 1 mg                                             Ibandronate sodium injection51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J1741001003Injection, ibuprofen, 100 mg                                                    Ibuprofen injection         51      A                                                                                                     C                          O1E 1P     02013010120130101        N                           
J1742001003Injection, ibutilide fumarate, 1 mg                                             Ibutilide fumarate injection51      A                  2049                                                                               DYY20080101                O1E 1P     01998010119980101        N                           
J1743001003Injection, idursulfase, 1 mg                                                    Idursulfase injection       51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N                           
J1744001003Injection, icatibant, 1 mg                                                      Icatibant injection         51      A                                                                                                     CYY20130101                O1E 1P     02013010120130101        N                           
J1745001003Injection, infliximab, excludes biosimilar, 10 mg                               Infliximab not biosimil 10mg51      A                  2049                                                                               DYY20080101                O1E 1P     02000010120170101        N                           
J1746001003Injection, ibalizumab-uiyk, 10 mg                                               Inj., ibalizumab-uiyk, 10 mg51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J1750001003Injection, iron dextran, 50 mg                                                  Inj iron dextran            51      A                  2049.5                                                                             DYY20090101                O1E 1P     02005123120090101        N                           
J1756001003Injection, iron sucrose, 1 mg                                                   Iron sucrose injection      51      A                                                                                                     C                          O1E 1P     02003010120030101        N                           
J1786001003Injection, imiglucerase, 10 units                                               Imuglucerase injection      51      A                  2049                                                                               DYY20110101                O1E 1P     02011010120110101        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                           
J1826001003Injection, interferon beta-1a, 30 mcg                                           Interferon beta-1a inj      00      9                                                                                                     CYY20170101                O1E 1      02011010120170101        N                           
J1830001003Injection, interferon beta-1b, 0.25 mg (code may be used for medicare when drug Interferon beta-1b / .25 mg 51      A                  2049                                                                               DYY20080101                O1E 1      01982010120000101        N                           
J1830002004administered under the direct supervision of a physician, not for use when drug                                                                                                                                                                                                                                      
J1830003004is self administered)                                                                                                                                                                                                                                                                                                
J1833001003Injection, isavuconazonium, 1 mg                                                Injection, isavuconazonium  51      A                                                                                                     CYY20160101                O1E 1      02016010120160101        N                           
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                           
J1930001003Injection, lanreotide, 1 mg                                                     Lanreotide injection        51      A                                                                                                     CYY20150101                O1E 1P     02009010120090101        N                           
J1931001003Injection, laronidase, 0.1 mg                                                   Laronidase injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J1940001003Injection, furosemide, up to 20 mg                                              Furosemide injection        51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J1942001003Injection, aripiprazole lauroxil, 1 mg                                          Aripiprazole lauroxil 1mg   51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J1945001003Injection, lepirudin, 50 mg                                                     Lepirudin                   51      A                  2049                                                                               D                      0095O1E 1P     02006010120180101        N                           
J1950001003Injection, leuprolide acetate (for depot suspension), per 3.75 mg               Leuprolide acetate /3.75 mg 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119970101        N                           
J1953001003Injection, levetiracetam, 10 mg                                                 Levetiracetam injection     51      A                                                                                                     C                          O1E 1P     02009010120090101        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                           
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, 200 mg                                                    Linezolid injection         51      A                                                                                                     C                          O1E 1P     02002010120180101        N                           
J2060001003Injection, lorazepam, 2 mg                                                      Lorazepam injection         51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
J2062001003Loxapine for inhalation, 1 mg                                                   Loxapine for inhalation 1 mg51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J2150001003Injection, mannitol, 25% in 50 ml                                               Mannitol injection          51      A                  2049                                                                               D                          O1E 1P     01986010119970101        N                           
J2170001003Injection, mecasermin, 1 mg                                                     Mecasermin injection        51      A                                                                                                     C                          O1E 1P     02007010120070101        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                           
J2182001003Injection, mepolizumab, 1 mg                                                    Injection, mepolizumab, 1mg 51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        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                           
J2212001003Injection, methylnaltrexone, 0.1 mg                                             Methylnaltrexone injection  51      A                                                                                                     C                          O1E 1P     02013010120130101        N                           
J2248001003Injection, micafungin sodium, 1 mg                                              Micafungin sodium injection 51      A                                                                                                     C                          O1E 1P     02007010120160101        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     01986010120180101        N                           
J2265001003Injection, minocycline hydrochloride, 1 mg                                      Minocycline hydrochloride   51      A                                                                                                     CYY20170101                O1E 1P     02012010120170101        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 100mg00      9                                                                                                     I                          O1E 1P     0199901012015010120141231N                           
J2274001003Injection, morphine sulfate, preservative-free for epidural or intrathecal use, Inj morphine pf epid ithc   51      A60-14             2049                                                                               D                          O1E 1P     02015010120180101        N                           
J227400200410 mg                                                                                                                                                                                                                                                                                                                
J2275001003Injection, morphine sulfate (preservative-free sterile solution), per 10 mg     Morphine sulfate injection  00      9                                                                                                     I                          O1E 1P     0199301012015010120141231N                           
J2278001003Injection, ziconotide, 1 microgram                                              Ziconotide injection        51      A                                                                                                     DYY20080101            0123O1E 1P     02006010120060101        N                           
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                           
J2315001003Injection, naltrexone, depot form, 1 mg                                         Naltrexone, depot form      51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J2320001003Injection, nandrolone decanoate, up to 50 mg                                    Nandrolone decanoate 50 mg  51      A                  2049                                                                               DYY20150101                O1E 1P     01986010119970101        N                           
J2323001003Injection, natalizumab, 1 mg                                                    Natalizumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N                           
J2325001003Injection, nesiritide, 0.1 mg                                                   Nesiritide injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N                           
J2326001003Injection, nusinersen, 0.1 mg                                                   Inj, nusinersen, 0.1mg      51      A                                                                                                     CYY20180101                O1E 1P     02018010120180101        N                           
J2350001003Injection, ocrelizumab, 1 mg                                                    Injection, ocrelizumab, 1 mg51      A                                                                                                     CYY20180101                O1E 1P     02018010120180101        N                           
J2353001003Injection, octreotide, depot form for intramuscular injection, 1 mg             Octreotide injection, depot 51      A                                                                                                     CYY20080101                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                                                                               DYY20080101                O1E 1P     01999010119990101        N                           
J2357001003Injection, omalizumab, 5 mg                                                     Omalizumab injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J2358001003Injection, olanzapine, long-acting, 1 mg                                        Olanzapine long-acting inj  51      A                                                                                                     C                          O1E 1P     02011010120180101        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                           
J2407001003Injection, oritavancin, 10 mg                                                   Injection, oritavancin      51      A                  2049                                                                               DYY20160101            0127O1E 1P     02016010120160101        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                                                                                                     CYY20080101                O1E 1P     02006010120060101        N                           
J2426001003Injection, paliperidone palmitate extended release, 1 mg                        Paliperidone palmitate inj  51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
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                                                                                                     CYY20080101                O1E 1P     02005010120090101        N                           
J2501001003Injection, paricalcitol, 1 mcg                                                  Paricalcitol                51      A                  2049                                                                               D                          O1E 1P     02003010120030101        N                           
J2502001003Injection, pasireotide long acting, 1 mg                                        Inj, pasireotide long acting51      A                                                                                                     CYY20160101                O1E 1      02016010120160101        N                           
J2503001003Injection, pegaptanib sodium, 0.3 mg                                            Pegaptanib sodium injection 51      A                                                                                                     C                      0095O1E 1P     02006010120190101        P                           
J2504001003Injection, pegademase bovine, 25 iu                                             Pegademase bovine, 25 iu    51      A                  2049                                                                               DYY20080101            0095O1E 1P     02006010120060101        N                           
J2505001003Injection, pegfilgrastim, 6 mg                                                  Injection, pegfilgrastim 6mg53      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N                           
J2507001003Injection, pegloticase, 1 mg                                                    Pegloticase injection       51      A                                                                                                     CYY20120101                O1E 1P     02012010120120101        N                           
J2510001003Injection, penicillin g procaine, aqueous, up to 600,000 units                  Penicillin g procaine inj   51      A                  2049                                                                               D                          O1E 1P     01982010120180101        N                           
J2513001003Injection, pentastarch, 10% solution, 100 ml                                    Pentastarch 10% solution    51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        N                           
J2515001003Injection, pentobarbital sodium, per 50 mg                                      Pentobarbital sodium inj    51      A                  2049                                                                               DYY20170101                O1E 1P     01982010120170101        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, fda-approved final product,       Pentamidine non-comp unit   51      A                                                                                                     D                      0127D1G 1P     01992010120080101        N                           
J2545002004non-compounded, administered through dme, unit dose form, per 300 mg                                                                                                                                                                                                                                                 
J2547001003Injection, peramivir, 1 mg                                                      Injection, peramivir        51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
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                           
J2562001003Injection, plerixafor, 1 mg                                                     Plerixafor injection        51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        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                                                                               DYY20130101                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     01986010120180101        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     01982010120140101        N                           
J2704001003Injection, propofol, 10 mg                                                      Inj, propofol, 10 mg        51      A                                                                                                     C                          O1E 1P     02015010120150101        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                           
J2724001003Injection, protein c concentrate, intravenous, human, 10 iu                     Protein c concentrate       51      A                                                                                                     CYY20080101                O1E 1P     02008010120090101        N                           
J2725001003Injection, protirelin, per 250 mcg                                              Inj protirelin per 250 mcg  51      A                  2049                                                                               D                          O1E 1P     01995010120140101        N                           
J2730001003Injection, pralidoxime chloride, up to 1 gm                                     Pralidoxime chloride inj    51      A                  2049                                                                               D                          O1E 1P     01986010120180101        N                           
J2760001003Injection, phentolamine mesylate, up to 5 mg                                    Phentolaine mesylate inj    51      A                  2049                                                                               DYY20140101                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                                                                               DYY20080101                O1E 1P     02001010120010101        N                           
J2778001003Injection, ranibizumab, 0.1 mg                                                  Ranibizumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02008010120080101        N                           
J2780001003Injection, ranitidine hydrochloride, 25 mg                                      Ranitidine hydrochloride inj51      A                  2049                                                                               D                          O1E 1P     02000010120000101        N                           
J2783001003Injection, rasburicase, 0.5 mg                                                  Rasburicase                 51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N                           
J2785001003Injection, regadenoson, 0.1 mg                                                  Regadenoson injection       51      A                                                                                                     C                          O1E 1P     02009010120140101        N                           
J2786001003Injection, reslizumab, 1 mg                                                     Injection, reslizumab, 1mg  51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J2788001003Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.)     Rho d immune globulin 50 mcg51      A                  2049                                                                               D                          O1E 1P     02003010120140101        N                           
J2790001003Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)  Rho d immune globulin inj   51      A                  2049                                                                               D                          O1E 1P     01986010120140101        N                           
J2791001003Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or        Rhophylac injection         51      A                  2049                                                                               D                          O1E 1P     02008010120160101        N                           
J2791002004intravenous, 100 iu                                                                                                                                                                                                                                                                                                  
J2792001003Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu Rho(d) immune globulin h, sd51      A                  2049                                                                               DYY20080101                O1E 1P     01999010119990101        N                           
J2793001003Injection, rilonacept, 1 mg                                                     Rilonacept injection        51      A                  2049                                                                               D                          O1E 1P     02010010120190101        P                           
J2794001003Injection, risperidone, long acting, 0.5 mg                                     Risperidone, long acting    51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J2795001003Injection, ropivacaine hydrochloride, 1 mg                                      Ropivacaine hcl injection   51      A                                                                                                     C                          O1E 1P     02001010120010101        N                           
J2796001003Injection, romiplostim, 10 micrograms                                           Romiplostim injection       51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N                           
J2797001003Injection, rolapitant, 0.5 mg                                                   Inj., rolapitant, 0.5 mg    51      A                                                                                                     DYY20190101            0127O1E 1P     02019010120190101        A                           
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        N                           
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                                                                               DYY20080101                O1E 1P     01982010119980101        N                           
J2840001003Injection, sebelipase alfa, 1 mg                                                Inj sebelipase alfa 1 mg    51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J2850001003Injection, secretin, synthetic, human, 1 microgram                              Inj secretin synthetic human51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N                           
J2860001003Injection, siltuximab, 10 mg                                                    Injection, siltuximab       51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
J2910001003Injection, aurothioglucose, up to 50 mg                                         Aurothioglucose injeciton   51      A                  2049                                                                               D                          O1E 1P     01982010119970101        N                           
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     02002010120190101        P                           
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                                                                               DYY20080101                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                                                                               DYY20080101                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 injection  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)                                                                                                                                                                                                                                                                                                
J3060001003Injection, taliglucerase alfa, 10 units                                         Inj, taliglucerase alfa 10 u51      A                                                                                                     CYY20140101                O1E 1P     02014010120140101        N                           
J3070001003Injection, pentazocine, 30 mg                                                   Pentazocine injection       51      A                  2049                                                                               D                          O1E 1P     01982010120190101        P                           
J3090001003Injection, tedizolid phosphate, 1 mg                                            Inj tedizolid phosphate     51      A                                                                                                     CYY20160101                O1E 1P     02016010120160101        N                           
J3095001003Injection, telavancin, 10 mg                                                    Telavancin injection        51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J3101001003Injection, tenecteplase, 1 mg                                                   Tenecteplase injection      51      A                                                                                                     CYY20090101                O1E 1P     02009010120090101        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     0198201012015010120141231N                           
J3121001003Injection, testosterone enanthate, 1 mg                                         Inj testostero enanthate 1mg51      A                                                                                                     D                      0194O1E 1P     02015010120150101        N                           
J3130001003Injection, testosterone enanthate, up to 200 mg                                 Testosterone enanthate inj  51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
J3140001003Injection, testosterone suspension, up to 50 mg                                 Testosterone suspension inj 51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
J3145001003Injection, testosterone undecanoate, 1 mg                                       Testosterone undecanoate 1mg51      A                                                                                                     DYY20150101            0127O1E 1      02015010120150101        N                           
J3150001003Injection, testosterone propionate, up to 100 mg                                Testosteron propionate inj  51      A                  2049                                                                               D                          O1E 1P     0198201012015010120141231N                           
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                                                                               DYY20080101                O1E 1P     01986010120030101        N                           
J3243001003Injection, tigecycline, 1 mg                                                    Tigecycline injection       51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J3245001003Injection, tildrakizumab, 1 mg                                                  Inj., tildrakizumab, 1 mg   51      A                                                                                                     C                          O1E 1P     02019010120190101        A                           
J3246001003Injection, tirofiban hcl, 0.25 mg                                               Tirofiban hcl               51      A                                                                                                     CYY20080101                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                           
J3262001003Injection, tocilizumab, 1 mg                                                    Tocilizumab injection       51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        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                                                                                                     CYY20080101                O1E 1P     02006010120060101        N                           
J3300001003Injection, triamcinolone acetonide, preservative free, 1 mg                     Triamcinolone a inj prs-free51      A                                                                                                     DYY20090101            0127O1E 1P     02009010120090101        N                           
J3301001003Injection, triamcinolone acetonide, not otherwise specified, 10 mg              Triamcinolone acet inj nos  51      A                  2049                                                                               D                          O1E 1P     01991010120090101        N                           
J3302001003Injection, triamcinolone diacetate, per 5 mg                                    Triamcinolone diacetate inj 51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J3303001003Injection, triamcinolone hexacetonide, per 5 mg                                 Triamcinolone hexacetonl inj51      A                  2049                                                                               D                          O1E 1P     01991010119970101        N                           
J3304001003Injection, triamcinolone acetonide, preservative-free, extended-release,        Inj triamcinolone ace xr 1mg51      A                                                                                                     DYY20190101            0127O1E 1P     02019010120190101        A                           
J3304002004microsphere formulation, 1 mg                                                                                                                                                                                                                                                                                        
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     01982010120140101        N                           
J3315001003Injection, triptorelin pamoate, 3.75 mg                                         Triptorelin pamoate         51      A                  2049                                                                               DYY20080101                O1E 1P     02003010120030101        N                           
J3316001003Injection, triptorelin, extended-release, 3.75 mg                               Inj., triptorelin xr 3.75 mg51      A                  2049                                                                               DYY20190101                O1E 1      02019010120190101        A                           
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     01986010120160101        N                           
J3355001003Injection, urofollitropin, 75 iu                                                Urofollitropin, 75 iu       51      A                  2049                                                                               D                      0095O1E 1P     02006010120180101        N                           
J3357001003Ustekinumab, for subcutaneous injection, 1 mg                                   Ustekinumab sub cu inj, 1 mg51      A                                                                                                     CYY20110101                O1E 1P     02011010120170101        N                           
J3358001003Ustekinumab, for intravenous injection, 1 mg                                    Ustekinumab, iv inject, 1 mg51      A                                                                            Q9989                    CYY20180101                O1E 1P     02018010120180101        N                           
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     01992010120180101        N                           
J3370001003Injection, vancomycin hcl, 500 mg                                               Vancomycin hcl injection    51      A60-14             2049                                                                               D                          O1E 1P     01986010120000101        N                           
J3380001003Injection, vedolizumab, 1 mg                                                    Injection, vedolizumab      51      A                                                                                                     DYY20160101            0127O1E 1P     02016010120160101        N                           
J3385001003Injection, velaglucerase alfa, 100 units                                        Velaglucerase alfa          51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J3396001003Injection, verteporfin, 0.1 mg                                                  Verteporfin injection       51      A                  35-100  45-30                                                                      DYY20080101                O1E 9      02005010120050101        N                           
J3397001003Injection, vestronidase alfa-vjbk, 1 mg                                         Inj., vestronidase alfa-vjbk51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J3398001003Injection, voretigene neparvovec-rzyl, 1 billion vector genomes                 Inj luxturna 1 billion vec g51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
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     02004010120190101        P                           
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        N                           
J3471002004usp units)                                                                                                                                                                                                                                                                                                           
J3472001003Injection, hyaluronidase, ovine, preservative free, per 1000 usp units          Ovine, 1000 usp units       51      A                                                                                                     D                      0123O1E 1P     02006010120060101        N                           
J3473001003Injection, hyaluronidase, recombinant, 1 usp unit                               Hyaluronidase recombinant   51      A                  2049                                                                               D                          O1E 1P     02007010120070101        N                           
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     02001010120160101        N                           
J3486001003Injection, ziprasidone mesylate, 10 mg                                          Ziprasidone mesylate        51      A                                                                                                     C                          O1E 1P     02004010120040101        N                           
J3489001003Injection, zoledronic acid, 1 mg                                                Zoledronic acid 1mg         51      A                                                                                                     C                          O1E 1P     02014010120180101        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                           
J3591001003Unclassified drug or biological used for esrd on dialysis                       Esrd on dialysi drug/bio noc51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
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                           
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                           
J71210010035% dextrose in lactated ringers infusion, up to 1000 cc                         5% dextrose in lac ringers  51      A                  2049                                                                               D                          O1E 1P     02016010120160101        N                           
J7131001003Hypertonic saline solution, 1 ml                                                Hypertonic saline sol       51      A                  2049                                                                               D                          O1E 1P     02012010120120101        N                           
J7170001003Injection, emicizumab-kxwh, 0.5 mg                                              Inj., emicizumab-kxwh 0.5 mg51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J7175001003Injection, factor x, (human), 1 i.u.                                            Inj, factor x, (human), 1iu 51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J7177001003Injection, human fibrinogen concentrate (fibryga), 1 mg                         Inj., fibryga, 1 mg         51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J7178001003Injection, human fibrinogen concentrate, not otherwise specified, 1 mg          Inj human fibrinogen con nos51      A                                                                                                     CYY20140401                O1E 1P     02013010120190101        C                           
J7179001003Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco      Vonvendi inj 1 iu vwf:rco   51      A                                                                                                     DYY20170101            0211O1E 1      02017010120170101        N                           
J7180001003Injection, factor xiii (antihemophilic factor, human), 1 i.u.                   Factor xiii anti-hem factor 51      A                                                                                                     CYY20160101                O1E 1P     02012010120160101        N                           
J7181001003Injection, factor xiii a-subunit, (recombinant), per iu                         Factor xiii recomb a-subunit51      A                                                                                                     CYY20150101                O1E 1P     02015010120150101        N                           
J7182001003Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per  Factor viii recomb novoeight51      A                                                                                                     CYY20170101                O1E 1P     02015010120170101        N                           
J7182002004iu                                                                                                                                                                                                                                                                                                                   
J7183001003Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco        Wilate injection            51      A                  2049                                                                               DYY20120101                O1E 1      02012010120120101        N                           
J7185001003Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u.  Xyntha inj                  51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N                           
J7186001003Injection, antihemophilic factor viii/von willebrand factor complex (human),    Antihemophilic viii/vwf comp51      A                  2049                                                                               DYY20090101                O1E 1P     02009010120090101        N                           
J7186002004per factor viii i.u.                                                                                                                                                                                                                                                                                                 
J7187001003Injection, von willebrand factor complex (humate-p), per iu vwf:rco             Humate-p, inj               51      A                  2049                                                                               DYY20080101                O1E 1P     02007010120080101        N                           
J7188001003Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. Factor viii recomb obizur   51      A                  2049                                                                               DYY20160101            0127O1E 1      02016010120160101        N                           
J7189001003Factor viia (antihemophilic factor, recombinant), per 1 microgram               Factor viia                 51      A                  2049                                                                               DYY20080101                O1E 1P     02006010120060101        N                           
J7190001003Factor viii (antihemophilic factor, human) per i.u.                             Factor viii                 51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119990101        N                           
J7191001003Factor viii (antihemophilic factor (porcine)), per i.u.                         Factor viii (porcine)       51      A                  2049                                                                               D                          O1E 1P     01996010120180101        N                           
J7192001003Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise        Factor viii recombinant nos 51      A                  2049                                                                               DYY20080101                O1E 1P     01994010120100101        N                           
J7192002004specified                                                                                                                                                                                                                                                                                                            
J7193001003Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.           Factor ix non-recombinant   51      A                  2049                                                                               DYY20080101                O1E 1P     02002010120020101        N                           
J7194001003Factor ix, complex, per i.u.                                                    Factor ix complex           51      A                  2049                                                                               DYY20080101                O1E 1P     01986010119980101        N                           
J7195001003Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise Factor ix recombinant nos   51      A                  2049                                                                               DYY20080101                O1E 1P     02002010120150101        N                           
J7195002004specified                                                                                                                                                                                                                                                                                                            
J7196001003Injection, antithrombin recombinant, 50 i.u.                                    Antithrombin recombinant    51      A                                                                                                     C                          O1E 1P     02011010120180101        N                           
J7197001003Antithrombin iii (human), per i.u.                                              Antithrombin iii injection  51      A                  2049                                                                               DYY20100101                O1E 1P     01992010119970101        N                           
J7198001003Anti-inhibitor, per i.u.                                                        Anti-inhibitor              51      A45-24             2049                                                                               DYY20080101                O1E 1P     02000010120000101        N                           
J7199001003Hemophilia clotting factor, not otherwise classified                            Hemophilia clot factor noc  51      A45-24             2049                                                                               D                          O1E 1P     02000010120000101        N                           
J7200001003Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu     Factor ix recombinan rixubis51      A                  2049                                                                               DYY20150101                O1E 1P     02015010120150101        N                           
J7201001003Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.        Factor ix alprolix recomb   51      A                  2049                                                                               DYY20150101                O1E 1P     02015010120170101        N                           
J7202001003Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.   Factor ix idelvion inj      51      A                                                                                                     DYY20170101            0211O1E 1      02017010120170101        N                           
J7203001003Injection factor ix, (antihemophilic factor, recombinant), glycopegylated,      Factor ix recomb gly rebinyn51      A                  2049                                                                               DYY20190101                O1E 1P     02019010120190101        A                           
J7203002004(rebinyn), 1 iu                                                                                                                                                                                                                                                                                                      
J7205001003Injection, factor viii fc fusion protein (recombinant), per iu                  Factor viii fc fusion recomb51      A                                                                                                     DYY20160101            0127O1E 1P     02016010120160101        N                           
J7207001003Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. Factor viii pegylated recomb51      A                                                                                                     DYY20170101            0127O1E 1      02017010120170101        N                           
J7209001003Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.   Factor viii nuwiq recomb 1iu51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J7210001003Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. Inj, afstyla, 1 i.u.        51      A                                                                                                     CYY20180101                O1E 1      02018010120180101        N                           
J7211001003Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.Inj, kovaltry, 1 i.u.       51      A                                                                                                     CYY20180101                O1E 1      02018010120180101        N                           
J7296001003Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg  Kyleena, 19.5 mg            00      9                                          1862(a)(1)                        Q9984                    S                          P6C 9      02018010120180101        N                           
J7297001003Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg     Liletta, 52 mg              00      9                                          1862(a)(1)                                                 S                          P6C 9      02016010120170101        N                           
J7298001003Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg      Mirena, 52 mg               00      9                                          1862(a)(1)                                                 S                          P6C 9      02016010120170101        N                           
J7300001003Intrauterine copper contraceptive                                               Intraut copper contraceptive00      9                                          1862A1                                                     S                          P6C 9      01986010119960101        N                           
J7301001003Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg     Skyla, 13.5 mg              00      9                                          1862(a)(1)                                                 S                          P6C 9      02014010120170101        N                           
J7302001003Levonorgestrel-releasing intrauterine contraceptive system, 52 mg               Levonorgestrel iu 52 mg     00      9                                          1862a1                                                     S                          P6C 9      0200201012016010120151231N                           
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        N                           
J7307001003Etonogestrel (contraceptive) implant system, including implant and supplies     Etonogestrel implant system 00      9                                                                                                     I                          Z2  9      02008010120080101        N                           
J7308001003Aminolevulinic acid hcl for topical administration, 20%, single unit dosage     Aminolevulinic acid hcl top 51      A                                                                                                     CYY20080101                O1E 1      02002010120040101        N                           
J7308002004form (354 mg)                                                                                                                                                                                                                                                                                                        
J7309001003Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram          Methyl aminolevulinate, top 51      A                                                                                                     D                      0165O1E 9      02011010120180101        N                           
J7310001003Ganciclovir, 4.5 mg, long-acting implant                                        Ganciclovir long act implant51      A                  2049                                                                               D                          O1E 9      01997010120180101        N                           
J7311001003Fluocinolone acetonide, intravitreal implant                                    Fluocinolone acetonide implt51      A                                                                                                     CYY20080101                O1E Q      02007010120070101        N                           
J7312001003Injection, dexamethasone, intravitreal implant, 0.1 mg                          Dexamethasone intra implant 51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J7313001003Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg                Fluocinol acet intravit imp 51      A                                                                                                     CYY20160101                O1E 1      02016010120160101        N                           
J7315001003Mitomycin, ophthalmic, 0.2 mg                                                   Ophthalmic mitomycin        51      A                                                                                                     C                          O1E 1P     02013010120160101        N                           
J7316001003Injection, ocriplasmin, 0.125 mg                                                Inj, ocriplasmin, 0.125 mg  51      A                                                                                                     CYY20140101                O1E 1P     02014010120140101        N                           
J7318001003Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg         Inj, durolane 1 mg          51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J7320001003Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg      Genvisc 850, inj, 1mg       51      A                                                                                                     CYY20180101                O1E 1      02017010120180101        N                           
J7321001003Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular      Hyalgan supartz visco-3 dose51      A                                                                                                     CYY20080101                O1E 1      02008010120180101        N                           
J7321002004injection, per dose                                                                                                                                                                                                                                                                                                  
J7322001003Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg          Hymovis injection 1 mg      51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J7323001003Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose     Euflexxa inj per dose       51      A                                                                                                     CYY20080101                O1E 1      02008010120080101        N                           
J7324001003Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose    Orthovisc inj per dose      51      A                                                                                                     CYY20080101                O1E 1      02008010120080101        N                           
J7325001003Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular           Synvisc or synvisc-one      51      A                                                                                                     CYY20100101                O1E 1      02010010120170101        N                           
J7325002004injection, 1 mg                                                                                                                                                                                                                                                                                                      
J7326001003Hyaluronan or derivative, gel-one, for intra-articular injection, per dose      Gel-one                     51      A                                                                                                     CYY20120101                O1E 1      02012010120170101        N                           
J7327001003Hyaluronan or derivative, monovisc, for intra-articular injection, per dose     Monovisc inj per dose       51      A                                                                                                     CYY20150101                O1E 1      02015010120150101        N                           
J7328001003Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg       Gelsyn-3 injection 0.1 mg   51      A                                                                                                     CYY20180101                O1E 1      02016010120180101        N                           
J7329001003Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg          Inj, trivisc 1 mg           51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
J7330001003Autologous cultured chondrocytes, implant                                       Cultured chondrocytes implnt57      A                                                                                                     C                          O1E 1P     02001010120020701        N                           
J7335001003Capsaicin 8% patch, per 10 square centimeters                                   Capsaicin 8% patch          51      A                                                                                                     C                          O1E 9      0201101012015010120141231N                           
J7336001003Capsaicin 8% patch, per square centimeter                                       Capsaicin 8% patch          51      A                                                                                                     CYY20150101                O1E 9      02015010120150101        N                           
J7340001003Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml                        Carbidopa levodopa ent 100ml51      A                                                                                                     C                          O1E P      02016010120190101        P                           
J7342001003Instillation, ciprofloxacin otic suspension, 6 mg                               Ciprofloxacin otic susp 6 mg51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J7345001003Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg              Aminolevulinic acid, 10% gel51      A                                                                                                     DYY20180101            0213O1E 1      02018010120180101        N                           
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                                                                               DYY20080101                O1E 1G     01988010120000101        N                           
J7502001003Cyclosporine, oral, 100 mg                                                      Cyclosporine oral 100 mg    57      A                  2049.5                                                                             D                          O1E 1G     02000010120000101        N                           
J7503001003Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg                      Tacrol envarsus ex rel oral 51      A                  2049.5                                                                             D                          O1E 1G     02016010120190101        P                           
J7504001003Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg  Lymphocyte immune globulin  51      A45-22             2049                                                                               DYY20080101                O1E 1G     01988010120020101        N                           
J7505001003Muromonab-cd3, parenteral, 5 mg                                                 Monoclonal antibodies       51      A                  2049                                                                               D                          O1E 1G     01988010120190101        P                           
J7506001003Prednisone, oral, per 5 mg                                                      Prednisone oral             51      A                  2049.5                                                                             D                          O1E 1G     0198901012016010120151231N                           
J7507001003Tacrolimus, immediate release, oral, 1 mg                                       Tacrolimus imme rel oral 1mg51      A                  2049.5                                                                             D                          O1E 1G     01995010120140101        N                           
J7508001003Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg                       Tacrol astagraf ex rel oral 51      A                  2049.5                                                                             D                          O1E 1G     02014010120180101        N                           
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, 25 mg   Antithymocyte globuln rabbit51      A                                                                                                     CYY20080101                O1E 1G     02002010120020101        N                           
J7512001003Prednisone, immediate release or delayed release, oral, 1 mg                    Prednisone ir or dr oral 1mg51      A                  2049.5                                                                             D                          O1E 1G     02016010120160101        N                           
J7513001003Daclizumab, parenteral, 25 mg                                                   Daclizumab, parenteral      51      A                  2049.5                                                                             D                          O1E 1G     01999010120180101        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                                                                             DYY20080101                O1E 1G     02001010120010101        N                           
J7527001003Everolimus, oral, 0.25 mg                                                       Oral everolimus             51      A                  2049.5                                                                             D                          O1G 1G     02013010120140101        N                           
J7599001003Immunosuppressive drug, not otherwise classified                                Immunosuppressive drug noc  51      A                  2049.5                                                                             D                          O1E 1G     01996010120000101        N                           
J7604001003Acetylcysteine, inhalation solution, compounded product, administered through   Acetylcysteine comp unit    51      A                                                                                                     C                          D1G 1P     02008010120080101        N                           
J7604002004dme, unit dose form, per gram                                                                                                                                                                                                                                                                                        
J7605001003Arformoterol, inhalation solution, fda approved final product, non-compounded,  Arformoterol non-comp unit  51      A                                                                                                     C                          D1G 1P     02008010120080101        N                           
J7605002004administered through dme, unit dose form, 15 micrograms                                                                                                                                                                                                                                                              
J7606001003Formoterol fumarate, inhalation solution, fda approved final product,           Formoterol fumarate, inh    51      A                                                                                                     C                          D1G 1P     02009010120090101        N                           
J7606002004non-compounded, administered through dme, unit dose form, 20 micrograms                                                                                                                                                                                                                                              
J7607001003Levalbuterol, inhalation solution, compounded product, administered through     Levalbuterol comp con       51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7607002004dme, concentrated form, 0.5 mg                                                                                                                                                                                                                                                                                       
J7608001003Acetylcysteine, inhalation solution, fda-approved final product,                Acetylcysteine non-comp unit51      A                                                                                                     D                      0135D1G 1P     02000010120080101        N                           
J7608002004non-compounded, administered through dme, unit dose form, per gram                                                                                                                                                                                                                                                   
J7609001003Albuterol, inhalation solution, compounded product, administered through dme,   Albuterol comp unit         51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7609002004unit dose, 1 mg                                                                                                                                                                                                                                                                                                      
J7610001003Albuterol, inhalation solution, compounded product, administered through dme,   Albuterol comp con          51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7610002004concentrated form, 1 mg                                                                                                                                                                                                                                                                                              
J7611001003Albuterol, inhalation solution, fda-approved final product, non-compounded,     Albuterol non-comp con      00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N                           
J7611002004administered through dme, concentrated form, 1 mg                                                                                                                                                                                                                                                                    
J7612001003Levalbuterol, inhalation solution, fda-approved final product, non-compounded,  Levalbuterol non-comp con   00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N                           
J7612002004administered through dme, concentrated form, 0.5 mg                                                                                                                                                                                                                                                                  
J7613001003Albuterol, inhalation solution, fda-approved final product, non-compounded,     Albuterol non-comp unit     00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N                           
J7613002004administered through dme, unit dose, 1 mg                                                                                                                                                                                                                                                                            
J7614001003Levalbuterol, inhalation solution, fda-approved final product, non-compounded,  Levalbuterol non-comp unit  00      9                  2100.5                                                                             D                          D1G 1P     02005010120090701        N                           
J7614002004administered through dme, unit dose, 0.5 mg                                                                                                                                                                                                                                                                          
J7615001003Levalbuterol, inhalation solution, compounded product, administered through     Levalbuterol comp unit      51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7615002004dme, unit dose, 0.5 mg                                                                                                                                                                                                                                                                                               
J7620001003Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved     Albuterol ipratrop non-comp 51      A                                                                                                     D                      0135D1G 1P     02006010120070101        N                           
J7620002004final product, non-compounded, administered through dme                                                                                                                                                                                                                                                              
J7622001003Beclomethasone, inhalation solution, compounded product, administered through   Beclomethasone comp unit    51      A                                                                                                     C                          D1G 1P     02002010120070101        N                           
J7622002004dme, unit dose form, per milligram                                                                                                                                                                                                                                                                                   
J7624001003Betamethasone, inhalation solution, compounded product, administered through    Betamethasone comp unit     51      A                                                                                                     C                          D1G 1P     02002010120070101        N                           
J7624002004dme, unit dose form, per milligram                                                                                                                                                                                                                                                                                   
J7626001003Budesonide, inhalation solution, fda-approved final product, non-compounded,    Budesonide non-comp unit    51      A                                                                                                     C                          D1G 1P     02002010120070101        N                           
J7626002004administered through dme, unit dose form, up to 0.5 mg                                                                                                                                                                                                                                                               
J7627001003Budesonide, inhalation solution, compounded product, administered through dme,  Budesonide comp unit        51      A                                                                                                     C                          D1G 1P     02006010120070101        N                           
J7627002004unit dose form, up to 0.5 mg                                                                                                                                                                                                                                                                                         
J7628001003Bitolterol mesylate, inhalation solution, compounded product, administered      Bitolterol mesylate comp con51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7628002004through dme, concentrated form, per milligram                                                                                                                                                                                                                                                                        
J7629001003Bitolterol mesylate, inhalation solution, compounded product, administered      Bitolterol mesylate comp unt51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7629002004through dme, unit dose form, per milligram                                                                                                                                                                                                                                                                           
J7631001003Cromolyn sodium, inhalation solution, fda-approved final product,               Cromolyn sodium noncomp unit51      A                                                                                                     D                      0135D1G 1P     02000010120080101        N                           
J7631002004non-compounded, administered through dme, unit dose form, per 10 milligrams                                                                                                                                                                                                                                          
J7632001003Cromolyn sodium, inhalation solution, compounded product, administered through  Cromolyn sodium comp unit   51      A                                                                                                     C                          D1G 1P     02008010120080101        N                           
J7632002004dme, unit dose form, per 10 milligrams                                                                                                                                                                                                                                                                               
J7633001003Budesonide, inhalation solution, fda-approved final product, non-compounded,    Budesonide non-comp con     51      A                                                                                                     C                          D1G 1P     02003010120070101        N                           
J7633002004administered through dme, concentrated form, per 0.25 milligram                                                                                                                                                                                                                                                      
J7634001003Budesonide, inhalation solution, compounded product, administered through dme,  Budesonide comp con         51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7634002004concentrated form, per 0.25 milligram                                                                                                                                                                                                                                                                                
J7635001003Atropine, inhalation solution, compounded product, administered through dme,    Atropine comp con           51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7635002004concentrated form, per milligram                                                                                                                                                                                                                                                                                     
J7636001003Atropine, inhalation solution, compounded product, administered through dme,    Atropine comp unit          51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7636002004unit dose form, per milligram                                                                                                                                                                                                                                                                                        
J7637001003Dexamethasone, inhalation solution, compounded product, administered through    Dexamethasone comp con      51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7637002004dme, concentrated form, per milligram                                                                                                                                                                                                                                                                                
J7638001003Dexamethasone, inhalation solution, compounded product, administered through    Dexamethasone comp unit     51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7638002004dme, unit dose form, per milligram                                                                                                                                                                                                                                                                                   
J7639001003Dornase alfa, inhalation solution, fda-approved final product, non-compounded,  Dornase alfa non-comp unit  51      A                                                                                                     D                      0135D1G 1P     02000010120090101        N                           
J7639002004administered through dme, unit dose form, per milligram                                                                                                                                                                                                                                                              
J7640001003Formoterol, inhalation solution, compounded product, administered through dme,  Formoterol comp unit        00      9                                                                                                     C                          D1G 1P     02006010120070101        N                           
J7640002004unit dose form, 12 micrograms                                                                                                                                                                                                                                                                                        
J7641001003Flunisolide, inhalation solution, compounded product, administered through dme, Flunisolide comp unit       51      A                                                                                                     C                          D1G 1P     02002010120070101        N                           
J7641002004unit dose, per milligram                                                                                                                                                                                                                                                                                             
J7642001003Glycopyrrolate, inhalation solution, compounded product, administered through   Glycopyrrolate comp con     51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7642002004dme, concentrated form, per milligram                                                                                                                                                                                                                                                                                
J7643001003Glycopyrrolate, inhalation solution, compounded product, administered through   Glycopyrrolate comp unit    51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7643002004dme, unit dose form, per milligram                                                                                                                                                                                                                                                                                   
J7644001003Ipratropium bromide, inhalation solution, fda-approved final product,           Ipratropium bromide non-comp51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7644002004non-compounded, administered through dme, unit dose form, per milligram                                                                                                                                                                                                                                              
J7645001003Ipratropium bromide, inhalation solution, compounded product, administered      Ipratropium bromide comp    51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7645002004through dme, unit dose form, per milligram                                                                                                                                                                                                                                                                           
J7647001003Isoetharine hcl, inhalation solution, compounded product, administered through  Isoetharine comp con        51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7647002004dme, concentrated form, per milligram                                                                                                                                                                                                                                                                                
J7648001003Isoetharine hcl, inhalation solution, fda-approved final product,               Isoetharine non-comp con    51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7648002004non-compounded, administered through dme, concentrated form, per milligram                                                                                                                                                                                                                                           
J7649001003Isoetharine hcl, inhalation solution, fda-approved final product,               Isoetharine non-comp unit   51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7649002004non-compounded, administered through dme, unit dose form, per milligram                                                                                                                                                                                                                                              
J7650001003Isoetharine hcl, inhalation solution, compounded product, administered through  Isoetharine comp unit       51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7650002004dme, unit dose form, per milligram                                                                                                                                                                                                                                                                                   
J7657001003Isoproterenol hcl, inhalation solution, compounded product, administered        Isoproterenol comp con      51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7657002004through dme, concentrated form, per milligram                                                                                                                                                                                                                                                                        
J7658001003Isoproterenol hcl, inhalation solution, fda-approved final product,             Isoproterenol non-comp con  51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7658002004non-compounded, administered through dme, concentrated form, per milligram                                                                                                                                                                                                                                           
J7659001003Isoproterenol hcl, inhalation solution, fda-approved final product,             Isoproterenol non-comp unit 51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7659002004non-compounded, administered through dme, unit dose form, per milligram                                                                                                                                                                                                                                              
J7660001003Isoproterenol hcl, inhalation solution, compounded product, administered        Isoproterenol comp unit     51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7660002004through dme, unit dose form, per milligram                                                                                                                                                                                                                                                                           
J7665001003Mannitol, administered through an inhaler, 5 mg                                 Mannitol for inhaler        51      A                                                                                                     C                          O1E 1      02012010120130101        N                           
J7667001003Metaproterenol sulfate, inhalation solution, compounded product, concentrated   Metaproterenol comp con     51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7667002004form, per 10 milligrams                                                                                                                                                                                                                                                                                              
J7668001003Metaproterenol sulfate, inhalation solution, fda-approved final product,        Metaproterenol non-comp con 51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7668002004non-compounded, administered through dme, concentrated form, per 10 milligrams                                                                                                                                                                                                                                       
J7669001003Metaproterenol sulfate, inhalation solution, fda-approved final product,        Metaproterenol non-comp unit51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7669002004non-compounded, administered through dme, unit dose form, per 10 milligrams                                                                                                                                                                                                                                          
J7670001003Metaproterenol sulfate, inhalation solution, compounded product, administered   Metaproterenol comp unit    51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7670002004through dme, unit dose form, 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                                                                                                                                                                                                                                                                                                             
J7676001003Pentamidine isethionate, inhalation solution, compounded product, administered  Pentamidine comp unit dose  51      A                                                                                                     C                          D1G 1P     02008010120080101        N                           
J7676002004through dme, unit dose form, per 300 mg                                                                                                                                                                                                                                                                              
J7680001003Terbutaline sulfate, inhalation solution, compounded product, administered      Terbutaline sulf comp con   51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7680002004through dme, concentrated form, per milligram                                                                                                                                                                                                                                                                        
J7681001003Terbutaline sulfate, inhalation solution, compounded product, administered      Terbutaline sulf comp unit  51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7681002004through dme, unit dose form, per milligram                                                                                                                                                                                                                                                                           
J7682001003Tobramycin, inhalation solution, fda-approved final product, non-compounded,    Tobramycin non-comp unit    51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7682002004unit dose form, administered through dme, per 300 milligrams                                                                                                                                                                                                                                                         
J7683001003Triamcinolone, inhalation solution, compounded product, administered through    Triamcinolone comp con      51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7683002004dme, concentrated form, per milligram                                                                                                                                                                                                                                                                                
J7684001003Triamcinolone, inhalation solution, compounded product, administered through    Triamcinolone comp unit     51      A                                                                                                     D                      0135D1G 1P     02000010120070101        N                           
J7684002004dme, unit dose form, per milligram                                                                                                                                                                                                                                                                                   
J7685001003Tobramycin, inhalation solution, compounded product, administered through dme,  Tobramycin comp unit        51      A                                                                                                     C                          D1G 1P     02007010120070101        N                           
J7685002004unit dose form, per 300 milligrams                                                                                                                                                                                                                                                                                   
J7686001003Treprostinil, inhalation solution, fda-approved final product, non-compounded,  Treprostinil, non-comp unit 51      A                                                                                                     C                          D1G 1P     02011010120110101        N                           
J7686002004administered through dme, unit dose form, 1.74 mg                                                                                                                                                                                                                                                                    
J7699001003Noc drugs, inhalation solution administered through dme                         Inhalation solution for dme 51      A                                                                                                     D                      0135D1G 1P     01993010120070101        N                           
J7799001003Noc drugs, other than inhalation drugs, administered through dme                Non-inhalation drug for dme 51      A                  2100.5                                                                             D                          D1G 1P     01993010120020701        N                           
J7999001003Compounded drug, not otherwise classified                                       Compounded drug, noc        51      A                                                                                                     D                      0205O1E 1      02016010120160101        N                           
J8498001003Antiemetic drug, rectal/suppository, not otherwise specified                    Antiemetic rectal/supp nos  51      A                                          1861s2T                                                    D                          O1D 1      02006010120060101        N                           
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 1      02005010120190101        P                           
J8510001003Busulfan; oral, 2 mg                                                            Oral busulfan               51      A                  2049.5                                                                             D                          O1D 1P     02000010120180101        N                           
J8515001003Cabergoline, oral, 0.25 mg                                                      Cabergoline, oral 0.25mg    00      9                  2049.5                                                                             M                          O1E 1P     02006010120060101        N                           
J8520001003Capecitabine, oral, 150 mg                                                      Capecitabine, oral, 150 mg  51      A                  2049.5                                                                             D                          O1D 1P     02000010120160101        N                           
J8521001003Capecitabine, oral, 500 mg                                                      Capecitabine, oral, 500 mg  51      A                  2049.5                                                                             D                          O1D 1P     02000010120160101        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        N                           
J8560001003Etoposide; oral, 50 mg                                                          Etoposide oral 50 mg        51      A                  2049.5                                                                             DYY20080101                O1D 1P     01995010119970101        N                           
J8562001003Fludarabine phosphate, oral, 10 mg                                              Oral fludarabine phosphate  51      A                                                                                                     CYY20190101                O1D 9      02011010120190101        P                           
J8565001003Gefitinib, oral, 250 mg                                                         Gefitinib oral              00      9                                                                                                     D                      0127O1E 9      02005010120150101        N                           
J8597001003Antiemetic drug, oral, not otherwise specified                                  Antiemetic drug oral nos    51      A                                          1861s2T                                                    D                          O1D 1      02006010120060101        N                           
J8600001003Melphalan; oral, 2 mg                                                           Melphalan oral 2 mg         51      A                  2049.5                                                                             DYY20190101                O1D 1P     01995010120190101        P                           
J8610001003Methotrexate; oral, 2.5 mg                                                      Methotrexate oral 2.5 mg    51      A                  2049.5                                                                             D                          O1D 1GP    01995010119970831        N                           
J8650001003Nabilone, oral, 1 mg                                                            Nabilone oral               51      A                                                                                                     C                          O1E 1G     02007010120180101        N                           
J8655001003Netupitant 300 mg and palonosetron 0.5 mg, oral                                 Oral netupitant, palonosetro51      A                                                                                                     DYY20160101            0204O1E 1      02016010120190101        C                           
J8670001003Rolapitant, oral, 1 mg                                                          Rolapitant, oral, 1mg       51      A                                                                                                     DYY20170101            0211O1E 1      02017010120170101        N                           
J8700001003Temozolomide, oral, 5 mg                                                        Temozolomide                51      A                  2049.5C                                                                            D                          O1D 1P     02001010120180101        N                           
J8705001003Topotecan, oral, 0.25 mg                                                        Topotecan oral              51      A                                                                                                     C                          O1D 1P     02009010120190101        P                           
J8999001003Prescription drug, oral, chemotherapeutic, nos                                  Oral prescription drug chemo51      A                  2049.5                                                                             D                          O1D 1P     01995010119970101        N                           
J9000001003Injection, doxorubicin hydrochloride, 10 mg                                     Doxorubicin hcl injection   51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N                           
J9010001003Injection, alemtuzumab, 10 mg                                                   Alemtuzumab injection       00      9                                                                            J0202                    I                          O1E 1P     0200301012016010120151231N                           
J9015001003Injection, aldesleukin, per single use vial                                     Aldesleukin injection       51      A                  2049                                                                               DYY20080101                O1D 1P     01996010120090101        N                           
J9017001003Injection, arsenic trioxide, 1 mg                                               Arsenic trioxide injection  51      A                                                                                                     CYY20080101                O1D 1P     02002010120090101        N                           
J9019001003Injection, asparaginase (erwinaze), 1,000 iu                                    Erwinaze injection          51      A                  2049                                                                               DYY20130101                O1D 1P     02013010120130101        N                           
J9020001003Injection, asparaginase, not otherwise specified, 10,000 units                  Asparaginase, nos           51      A                  2049                                                                               D                          O1D 1P     01984010120160101        N                           
J9022001003Injection, atezolizumab, 10 mg                                                  Inj, atezolizumab,10 mg     51      A                                                                                                     CYY20180101                O1D 1P     02018010120180101        N                           
J9023001003Injection, avelumab, 10 mg                                                      Injection, avelumab, 10 mg  51      A                                                                                                     CYY20180101                O1E 1      02018010120180101        N                           
J9025001003Injection, azacitidine, 1 mg                                                    Azacitidine injection       51      A                                                                                                     CYY20080101                O1D 1P     02006010120060101        N                           
J9027001003Injection, clofarabine, 1 mg                                                    Clofarabine injection       51      A                                                                                                     CYY20080101                O1E 1P     02006010120060101        N                           
J9031001003Bcg (intravesical) per instillation                                             Bcg live intravesical vac   51      A                  2049                                                                               DYY20080101                O1D 1P     01991010119970101        N                           
J9032001003Injection, belinostat, 10 mg                                                    Injection, belinostat, 10mg 51      A                                                                                                     CYY20160101                O1D 1P     02016010120160101        N                           
J9033001003Injection, bendamustine hcl (treanda), 1 mg                                     Inj., treanda 1 mg          51      A                                                                                                     CYY20090101                O1D 1P     02009010120170101        N                           
J9034001003Injection, bendamustine hcl (bendeka), 1 mg                                     Inj., bendeka 1 mg          51      A                                                                                                     CYY20170101                O1D 1P     02017010120170101        N                           
J9035001003Injection, bevacizumab, 10 mg                                                   Bevacizumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J9039001003Injection, blinatumomab, 1 microgram                                            Injection, blinatumomab     51      A                                                                                                     CYY20160101                O1D 1P     02016010120160101        N                           
J9040001003Injection, bleomycin sulfate, 15 units                                          Bleomycin sulfate injection 51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N                           
J9041001003Injection, bortezomib (velcade), 0.1 mg                                         Inj., velcade 0.1 mg        51      A                                                                                                     CYY20080101                O1E 1P     02005010120190101        C                           
J9042001003Injection, brentuximab vedotin, 1 mg                                            Brentuximab vedotin inj     51      A                                                                                                     CYY20130101                O1D 1P     02013010120130101        N                           
J9043001003Injection, cabazitaxel, 1 mg                                                    Cabazitaxel injection       51      A                                                                                                     CYY20120101                O1D 1P     02012010120120101        N                           
J9044001003Injection, bortezomib, not otherwise specified, 0.1 mg                          Inj, bortezomib, nos, 0.1 mg51      A                                                                                                     CYY20190101                O1E 1P     02019010120190101        A                           
J9045001003Injection, carboplatin, 50 mg                                                   Carboplatin injection       51      A                  2049                                                                               D                          O1D 1P     01990010120090101        N                           
J9047001003Injection, carfilzomib, 1 mg                                                    Injection, carfilzomib, 1 mg51      A                                                                                                     CYY20140101                O1D 1P     02014010120140101        N                           
J9050001003Injection, carmustine, 100 mg                                                   Carmustine injection        51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N                           
J9055001003Injection, cetuximab, 10 mg                                                     Cetuximab injection         51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J9057001003Injection, copanlisib, 1 mg                                                     Inj., copanlisib, 1 mg      51      A                                                                                                     CYY20190101                O1D 1P     02019010120190101        A                           
J9060001003Injection, cisplatin, powder or solution, 10 mg                                 Cisplatin 10 mg injection   51      A                  2049                                                                               D                          O1D 1P     01984010120110101        N                           
J9065001003Injection, cladribine, per 1 mg                                                 Inj cladribine per 1 mg     51      A                  2049                                                                               DYY20080101                O1D 1P     01995010119970101        N                           
J9070001003Cyclophosphamide, 100 mg                                                        Cyclophosphamide 100 mg inj 51      A                  2049                                                                               DYY20120101                O1D 1P     01984010119970101        N                           
J9098001003Injection, cytarabine liposome, 10 mg                                           Cytarabine liposome inj     51      A                                                                                                     CYY20080101                O1E 1P     02004010120090101        N                           
J9100001003Injection, cytarabine, 100 mg                                                   Cytarabine hcl 100 mg inj   51      A                  2049                                                                               D                          O1D 1P     01986010120090101        N                           
J9120001003Injection, dactinomycin, 0.5 mg                                                 Dactinomycin injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N                           
J9130001003Dacarbazine, 100 mg                                                             Dacarbazine 100 mg inj      51      A                  2049                                                                               D                          O1D 1P     01986010120040101        N                           
J9145001003Injection, daratumumab, 10 mg                                                   Injection, daratumumab 10 mg51      A                  2049                                                                               DYY20170101                O1D 1P     02017010120170101        N                           
J9150001003Injection, daunorubicin, 10 mg                                                  Daunorubicin injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120090101        N                           
J9151001003Injection, daunorubicin citrate, liposomal formulation, 10 mg                   Daunorubicin citrate inj    51      A                  2049                                                                               DYY20190101                O1D 1P     01999010120190101        P                           
J9153001003Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine                  Inj daunorubicin, cytarabine51      A                                                                                                     CYY20190101                O1D 1      02019010120190101        A                           
J9155001003Injection, degarelix, 1 mg                                                      Degarelix injection         51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N                           
J9160001003Injection, denileukin diftitox, 300 micrograms                                  Denileukin diftitox inj     51      A                                                                                                     C                          O1E 1P     02001010120090101        N                           
J9165001003Injection, diethylstilbestrol diphosphate, 250 mg                               Diethylstilbestrol injection51      A                  2049                                                                               D                          O1D 1P     01988010120090101        N                           
J9171001003Injection, docetaxel, 1 mg                                                      Docetaxel injection         51      A                  2049                                                                               DYY20100101                O1E 1P     02010010120100101        N                           
J9173001003Injection, durvalumab, 10 mg                                                    Inj., durvalumab, 10 mg     51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J9175001003Injection, elliotts' b solution, 1 ml                                           Elliotts b solution per ml  51      A                  2049                                                                               D                      0095O1E 1P     02006010120060101        N                           
J9176001003Injection, elotuzumab, 1 mg                                                     Injection, elotuzumab, 1mg  51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J9178001003Injection, epirubicin hcl, 2 mg                                                 Inj, epirubicin hcl, 2 mg   51      A                                                                                                     C                          O1E 1P     02004010120140101        N                           
J9179001003Injection, eribulin mesylate, 0.1 mg                                            Eribulin mesylate injection 51      A                                                                                                     CYY20120101                O1D 1P     02012010120120101        N                           
J9181001003Injection, etoposide, 10 mg                                                     Etoposide injection         51      A                  2049                                                                               D                          O1D 1P     01987010120090101        N                           
J9185001003Injection, fludarabine phosphate, 50 mg                                         Fludarabine phosphate inj   51      A                  2049                                                                               D                          O1D 1P     01994010120190101        P                           
J9190001003Injection, fluorouracil, 500 mg                                                 Fluorouracil injection      51      A                  2049                                                                               D                          O1D 1P     01984010120090101        N                           
J9200001003Injection, floxuridine, 500 mg                                                  Floxuridine injection       51      A                  2049                                                                               D                          O1D 1P     01984010120180101        N                           
J9201001003Injection, gemcitabine hydrochloride, 200 mg                                    Gemcitabine hcl injection   51      A                  2049                                                                               D                          O1D 1P     01998010120140101        N                           
J9202001003Goserelin acetate implant, per 3.6 mg                                           Goserelin acetate implant   51      A                  2049                                                                               DYY20080101                O1D 1P     01991010119970101        N                           
J9203001003Injection, gemtuzumab ozogamicin, 0.1 mg                                        Gemtuzumab ozogamicin 0.1 mg51      A                                                                                                     CYY20180101                O1D 1P     02018010120180101        N                           
J9205001003Injection, irinotecan liposome, 1 mg                                            Inj irinotecan liposome 1 mg51      A                  2049                                                                               DYY20170101                O1D 1      02017010120170101        N                           
J9206001003Injection, irinotecan, 20 mg                                                    Irinotecan injection        51      A                  2049                                                                               D                          O1D 1P     01998010120090101        N                           
J9207001003Injection, ixabepilone, 1 mg                                                    Ixabepilone injection       51      A                                                                                                     CYY20090101                O1D 1P     02009010120090101        N                           
J9208001003Injection, ifosfamide, 1 gram                                                   Ifosfamide injection        51      A                  2049                                                                               D                          O1D 1P     01990010120180101        N                           
J9209001003Injection, mesna, 200 mg                                                        Mesna injection             51      A                  2049                                                                               D                          O1D 1P     01990010120090101        N                           
J9211001003Injection, idarubicin hydrochloride, 5 mg                                       Idarubicin hcl injection    51      A                  2049                                                                               D                          O1D 1P     01993010120190101        P                           
J9212001003Injection, interferon alfacon-1, recombinant, 1 microgram                       Interferon alfacon-1 inj    51      A                  2049                                                                               D                          O1E 1P     01999010120140101        N                           
J9213001003Injection, interferon, alfa-2a, recombinant, 3 million units                    Interferon alfa-2a inj      51      A                  2049                                                                               DYY20190101                O1D G      01993010120190101        P                           
J9214001003Injection, interferon, alfa-2b, recombinant, 1 million units                    Interferon alfa-2b inj      51      A                  2049                                                                               DYY20080101                O1D G      01993010120090101        N                           
J9215001003Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu           Interferon alfa-n3 inj      51      A                  2049                                                                               D                          O1D G      01993010120090101        N                           
J9216001003Injection, interferon, gamma 1-b, 3 million units                               Interferon gamma 1-b inj    51      A                  2049                                                                               D                          O1D G      01993010120190101        P                           
J9217001003Leuprolide acetate (for depot suspension), 7.5 mg                               Leuprolide acetate suspnsion51      A                  2049                                                                               DYY20080101                O1D 1P     01991010119970101        N                           
J9218001003Leuprolide acetate, per 1 mg                                                    Leuprolide acetate injeciton51      A                  2049                                                                               D                      0014O1D 1P     01990010120190101        P                           
J9219001003Leuprolide acetate implant, 65 mg                                               Leuprolide acetate implant  51      A                  2049                                                                               D                          O1D 1P     02001010120180101        N                           
J9225001003Histrelin implant (vantas), 50 mg                                               Vantas implant              51      A                  2049                                                                               DYY20080101                O1D 1P     02006010120080101        N                           
J9226001003Histrelin implant (supprelin la), 50 mg                                         Supprelin la implant        51      A                  2049                                                                               DYY20080101                O1D 1P     02008010120080101        N                           
J9228001003Injection, ipilimumab, 1 mg                                                     Ipilimumab injection        51      A                                                                                                     CYY20120101                O1D 1P     02012010120120101        N                           
J9229001003Injection, inotuzumab ozogamicin, 0.1 mg                                        Inj inotuzumab ozogam 0.1 mg51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
J9230001003Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg             Mechlorethamine hcl inj     51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120090101        N                           
J9245001003Injection, melphalan hydrochloride, 50 mg                                       Inj melphalan hydrochl 50 mg51      A                  2049                                                                               DYY20080101                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                           
J9261001003Injection, nelarabine, 50 mg                                                    Nelarabine injection        51      A                                                                                                     CYY20080101                O1E 1P     02007010120070101        N                           
J9262001003Injection, omacetaxine mepesuccinate, 0.01 mg                                   Inj, omacetaxine mep, 0.01mg51      A                                                                                                     CYY20140101                O1D 1P     02014010120140101        N                           
J9263001003Injection, oxaliplatin, 0.5 mg                                                  Oxaliplatin                 51      A                                                                                                     C                          O1D 1P     02004010120180101        N                           
J9264001003Injection, paclitaxel protein-bound particles, 1 mg                             Paclitaxel protein bound    51      A                                                                                                     CYY20080101                O1E 1P     02006010120070101        N                           
J9265001003Injection, paclitaxel, 30 mg                                                    Paclitaxel injection        51      A                  2049                                                                               D                          O1D 1P     0199401012015010120141231N                           
J9266001003Injection, pegaspargase, per single dose vial                                   Pegaspargase injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01996010120090101        N                           
J9267001003Injection, paclitaxel, 1 mg                                                     Paclitaxel injection        51      A                                                                                                     D                      0194O1D 1P     02015010120150101        N                           
J9268001003Injection, pentostatin, 10 mg                                                   Pentostatin injection       51      A                  2049                                                                               DYY20080101                O1D 1P     01994010120090101        N                           
J9270001003Injection, plicamycin, 2.5 mg                                                   Plicamycin (mithramycin) inj51      A                  2049                                                                               DYY20190101                O1D 1P     01984010120190101        P                           
J9271001003Injection, pembrolizumab, 1 mg                                                  Inj pembrolizumab           51      A                                                                                                     CYY20160101                O1D 1P     02016010120160101        N                           
J9280001003Injection, mitomycin, 5 mg                                                      Mitomycin injection         51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120130101        N                           
J9285001003Injection, olaratumab, 10 mg                                                    Inj, olaratumab, 10 mg      51      A                                                                                                     CYY20180101                O1D 1      02018010120180101        N                           
J9293001003Injection, mitoxantrone hydrochloride, per 5 mg                                 Mitoxantrone hydrochl / 5 mg51      A                  2049                                                                               DYY20080101                O1D 1P     01990010119970101        N                           
J9295001003Injection, necitumumab, 1 mg                                                    Injection, necitumumab, 1 mg51      A                                                                                                     CYY20170101                O1D 1      02017010120170101        N                           
J9299001003Injection, nivolumab, 1 mg                                                      Injection, nivolumab        51      A                                                                                                     DYY20160101            0127O1D 1P     02016010120160101        N                           
J9300001003Injection, gemtuzumab ozogamicin, 5 mg                                          Gemtuzumab ozogamicin inj   51      A                                                                                                     C                          O1D 1P     0200201012018010120171231N                           
J9301001003Injection, obinutuzumab, 10 mg                                                  Obinutuzumab inj            51      A                                                                                                     CYY20150101                O1D 1P     02015010120150101        N                           
J9302001003Injection, ofatumumab, 10 mg                                                    Ofatumumab injection        51      A                                                                                                     CYY20110101                O1D 1P     02011010120110101        N                           
J9303001003Injection, panitumumab, 10 mg                                                   Panitumumab injection       51      A                                                                                                     CYY20080101                O1D 1P     02008010120080101        N                           
J9305001003Injection, pemetrexed, 10 mg                                                    Pemetrexed injection        51      A                                                                                                     CYY20080101                O1E 1P     02005010120050101        N                           
J9306001003Injection, pertuzumab, 1 mg                                                     Injection, pertuzumab, 1 mg 51      A                                                                                                     CYY20140101                O1D 1      02014010120140101        N                           
J9307001003Injection, pralatrexate, 1 mg                                                   Pralatrexate injection      51      A                                                                                                     CYY20110101                O1E 1P     02011010120110101        N                           
J9308001003Injection, ramucirumab, 5 mg                                                    Injection, ramucirumab      51      A                                                                                                     CYY20160101                O1D 1P     02016010120160101        N                           
J9310001003Injection, rituximab, 100 mg                                                    Rituximab injection         51      A                  2049                                                                               DYY20080101                O1D 1P     0199901012019010120181231D                           
J9311001003Injection, rituximab 10 mg and hyaluronidase                                    Inj rituximab, hyaluronidase51      A                  2049                                                                               DYY20190101                O1D 1P     02019010120190101        A                           
J9312001003Injection, rituximab, 10 mg                                                     Inj., rituximab, 10 mg      51      A                  2049                                                                               DYY20190101                O1D 1P     02019010120190101        A                           
J9315001003Injection, romidepsin, 1 mg                                                     Romidepsin injection        51      A                                                                                                     CYY20110101                O1D 1P     02011010120110101        N                           
J9320001003Injection, streptozocin, 1 gram                                                 Streptozocin injection      51      A                  2049                                                                               DYY20080101                O1D 1P     01986010120090101        N                           
J9325001003Injection, talimogene laherparepvec, per 1 million plaque forming units         Inj talimogene laherparepvec51      A                                                                                                     CYY20170101                O1E 1      02017010120170101        N                           
J9328001003Injection, temozolomide, 1 mg                                                   Temozolomide injection      51      A                                                                                                     CYY20100101                O1D 1P     02010010120100101        N                           
J9330001003Injection, temsirolimus, 1 mg                                                   Temsirolimus injection      51      A                                                                                                     CYY20090101                O1D 1P     02009010120090101        N                           
J9340001003Injection, thiotepa, 15 mg                                                      Thiotepa injection          51      A                  2049                                                                               DYY20080101                O1D 1P     01984010120090101        N                           
J9351001003Injection, topotecan, 0.1 mg                                                    Topotecan injection         51      A                                                                                                     C                          O1D 1P     02011010120180101        N                           
J9352001003Injection, trabectedin, 0.1 mg                                                  Injection trabectedin 0.1mg 51      A                                                                                                     CYY20170101                O1D 1      02017010120170101        N                           
J9354001003Injection, ado-trastuzumab emtansine, 1 mg                                      Inj, ado-trastuzumab emt 1mg51      A                                                                                                     CYY20140101                O1D 1P     02014010120140101        N                           
J9355001003Injection, trastuzumab, 10 mg                                                   Trastuzumab injection       51      A                                                                                                     CYY20080101                O1E 1P     02000010120090101        N                           
J9357001003Injection, valrubicin, intravesical, 200 mg                                     Valrubicin injection        51      A                  2049                                                                               DYY20080101                O1E 1P     02000010120090101        N                           
J9360001003Injection, vinblastine sulfate, 1 mg                                            Vinblastine sulfate inj     51      A                  2049                                                                               D                          O1D 1P     01986010120090101        N                           
J9370001003Vincristine sulfate, 1 mg                                                       Vincristine sulfate 1 mg inj51      A                  2049                                                                               D                          O1D 1P     01986010119970101        N                           
J9371001003Injection, vincristine sulfate liposome, 1 mg                                   Inj, vincristine sul lip 1mg51      A                                                                                                     CYY20140101                O1D 1P     02014010120140101        N                           
J9390001003Injection, vinorelbine tartrate, 10 mg                                          Vinorelbine tartrate inj    51      A                  2049                                                                               D                          O1D 1P     01996010120090101        N                           
J9395001003Injection, fulvestrant, 25 mg                                                   Injection, fulvestrant      51      A                                                                                                     CYY20080101                O1E 1P     02004010120040101        N                           
J9400001003Injection, ziv-aflibercept, 1 mg                                                Inj, ziv-aflibercept, 1mg   51      A                                                                                                     CYY20140101                O1E 1      02014010120140101        N                           
J9600001003Injection, porfimer sodium, 75 mg                                               Porfimer sodium injection   51      A                  2049                                                                               DYY20080101                O1D 1P     01998010120090101        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                           
K0008001003Custom manual wheelchair/base                                                   Cstm manual wheelchair/base 45      A                                                                                                     D                      0188D1D APR    02013070120130701        N                           
K0009001003Other manual wheelchair/base                                                    Other manual wheelchair/base36      A                                                                                                     C                          D1D APR    01994010120130701        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                           
K0013001003Custom motorized/power wheelchair base                                          Custom power whlchr base    45      A                                                                                                     D                      0188D1D APR    02013070120130701        N                           
K0014001003Other motorized/power wheelchair base                                           Other power whlchr base     36      A                                                                                                     C                          D1D APR    01994010120010101        N                           
K0015001003Detachable, non-adjustable height armrest, replacement only, each               Detach non-adj ht armrst rep36      A                                                                                                     C                          D1D APR    01994010120160701        N                           
K0017001003Detachable, adjustable height armrest, base, replacement only, each             Detach adjust armrest base  32      A                                                                                                     C                          D1D APR    01994010120160101        N                           
K0018001003Detachable, adjustable height armrest, upper portion, replacement only, each    Detach adjust armrst upper  32      A                                                                                                     C                          D1D APR    01994010120160101        N                           
K0019001003Arm pad, replacement only, each                                                 Arm pad repl, each          32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0020001003Fixed, adjustable height armrest, pair                                          Fixed adjust armrest pair   32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0037001003High mount flip-up footrest, each                                               Hi mount flip-up footrest ea32      A                                                                                                     C                          D1D APR    01994010120181001        C                           
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, replacement only, each                                 Standard size ftplate rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0043001003Footrest, lower extension tube, replacement only, each                          Ftrst lowr exten tube rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0044001003Footrest, upper hanger bracket, replacement only, each                          Ftrst upr hanger brac rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0045001003Footrest, complete assembly, replacement only, each                             Ftrst compl assembly repl ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0046001003Elevating legrest, lower extension tube, replacement only, each                 Elev lgrst lwr exten repl ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0047001003Elevating legrest, upper hanger bracket, replacement only, each                 Elev legrst upr hangr rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0050001003Ratchet assembly, replacement only                                              Ratchet assembly replacement32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0051001003Cam release assembly, footrest or legrest, replacement only, each               Cam rel asm ft/legrst rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0052001003Swingaway, detachable footrests, replacement only, each                         Swingaway detach ftrest repl32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0053001003Elevating footrests, articulating (telescoping), each                           Elevate footrest articulate 32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0056001003Seat height less than 17" or equal to or greater than 21" for a high strength,  Seat ht <17 or >=21 ltwt wc 32      A                                                                                                     C                          D1D APR    01994010119990101        N                           
K0056002004lightweight, or ultralightweight wheelchair                                                                                                                                                                                                                                                                          
K0065001003Spoke protectors, each                                                          Spoke protectors            32      A                                                                                                     C                          D1D APR    01994010120000101        N                           
K0069001003Rear wheel assembly, complete, with solid tire, spokes or molded, replacement   Rr whl compl sol tire rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0069002004only, each                                                                                                                                                                                                                                                                                                           
K0070001003Rear wheel assembly, complete, with pneumatic tire, spokes or molded,           Rr whl compl pne tire rep ea36      A                                                                                                     C                          D1D APR    01994010120160701        N                           
K0070002004replacement only, each                                                                                                                                                                                                                                                                                               
K0071001003Front caster assembly, complete, with pneumatic tire, replacement only, each    Fr cstr comp pne tire rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0072001003Front caster assembly, complete, with semi-pneumatic tire, replacement only,    Fr cstr semi-pne tire rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0072002004each                                                                                                                                                                                                                                                                                                                 
K0073001003Caster pin lock, each                                                           Caster pin lock each        32      A                                                                                                     C                          D1D APR    01994010119940101        N                           
K0077001003Front caster assembly, complete, with solid tire, replacement only, each        Fr cstr asmb sol tire rep ea32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0098001003Drive belt for power wheelchair, replacement only                               Drive belt for pwc, repl    32      A                                                                                                     C                          D1D APR    01994010120170101        N                           
K0105001003Iv hanger, each                                                                 Iv hanger                   32      A                                                                                                     C                          D1D APR    01994010120000101        N                           
K0108001003Wheelchair component or accessory, not otherwise specified                      W/c component-accessory nos 46      A                                                                                                     C                          D1D APR    01994010119990701        N                           
K0195001003Elevating leg rests, pair (for use with capped rental wheelchair base)          Elevating whlchair leg rests36      A60-9                                                                                                 D                          D1D R      01993010119930101        N                           
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)                                                                                                                                                                                                                                                                                 
K0462001003Temporary replacement for patient owned equipment being repaired, any type      Temporary replacement eqpmnt32      A                  5102.3                                                                             D                          D1E 9      01998070119980701        N                           
K0552001003Supplies for external non-insulin drug infusion pump, syringe type cartridge,   Sup/ext non-ins inf pump syr34      A60-14                                                                                                D                          D1E P      02003070120170101        N                           
K0552002004sterile, each                                                                                                                                                                                                                                                                                                        
K0553001003Supply allowance for therapeutic continuous glucose monitor (cgm), includes all Ther cgm supply allowance   34      A                                                                                                     D                      0212D1E 9      02017070120170701        N                           
K0553002004supplies and accessories, 1 month supply = 1 unit of service                                                                                                                                                                                                                                                         
K0554001003Receiver (monitor), dedicated, for use with therapeutic glucose continuous      Ther cgm receiver/monitor   32      A                                                                                                     D                      0212D1E APR    02017070120170701        N                           
K0554002004monitor system                                                                                                                                                                                                                                                                                                       
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           36      A                                                                                                     C                          D1E APR    02003070120140401        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                                                                                                                                                                                                                                                                                                      
K0669001003Wheelchair accessory, wheelchair seat or back cushion, does not meet specific   Seat/back cus no dmepdac ver32      A                                                                                                     C                          D1D APR    02004070120100701        N                           
K0669002004code criteria or no written coding verification from dme pdac                                                                                                                                                                                                                                                        
K0672001003Addition to lower extremity orthosis, removable soft interface, all components, Removable soft interface le 38      A                                                                                                     C                          D1F P      02008040120080401        N                           
K0672002004replacement only, each                                                                                                                                                                                                                                                                                               
K0730001003Controlled dose inhalation drug delivery system                                 Ctrl dose inh drug deliv sys36      A                                                                                                     C                          D1E R      02005070120140401        N                           
K0733001003Power wheelchair accessory, 12 to 24 amp hour sealed lead acid battery, each    12-24hr sealed lead acid    32      A                                                                                                     C                          D1D APR    02006070120060701        N                           
K0733002004(e.g., gel cell, absorbed glassmat)                                                                                                                                                                                                                                                                                  
K0738001003Portable gaseous oxygen system, rental; home compressor used to fill portable   Portable gas oxygen system  33      A                                                                                                     C                          D1C PR     02006100120061001        N                           
K0738002004oxygen cylinders; includes portable containers, regulator, flowmeter,                                                                                                                                                                                                                                                
K0738003004humidifier, cannula or mask, and tubing                                                                                                                                                                                                                                                                              
K0739001003Repair or nonroutine service for durable medical equipment other than oxygen    Repair/svc dme non-oxygen eq46      A                                                                                                     C                          D1E 9      02009040120090401        N                           
K0739002004equipment requiring the skill of a technician, labor component, per 15 minutes                                                                                                                                                                                                                                       
K0740001003Repair or nonroutine service for oxygen equipment requiring the skill of a      Repair/svc oxygen equipment 00      9                                                                                                     M                      0157D1C 9      02009040120090401        N                           
K0740002004technician, labor component, per 15 minutes                                                                                                                                                                                                                                                                          
K0743001003Suction pump, home model, portable, for use on wounds                           Portable home suction pump  36      A                                                                                                     C                          D1E R      02011070120110701        N                           
K0744001003Absorptive wound dressing for use with suction pump, home model, portable, pad  Absorp drg <= 16 suc pump   34      A                                                                                                     C                          D1E S      02011070120110701        N                           
K0744002004size 16 square inches or less                                                                                                                                                                                                                                                                                        
K0745001003Absorptive wound dressing for use with suction pump, home model, portable, pad  Absorp drg >16<=48 suc pump 34      A                                                                                                     C                          D1E S      02011070120110701        N                           
K0745002004size more than 16 square inches but less than or equal to 48 square inches                                                                                                                                                                                                                                           
K0746001003Absorptive wound dressing for use with suction pump, home model, portable, pad  Absorp drg >48 suc pump     34      A                                                                                                     C                          D1E S      02011070120110701        N                           
K0746002004size greater than 48 square inches                                                                                                                                                                                                                                                                                   
K0800001003Power operated vehicle, group 1 standard, patient weight capacity up to and     Pov group 1 std up to 300lbs32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0800002004including 300 pounds                                                                                                                                                                                                                                                                                                 
K0801001003Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450  Pov group 1 hd 301-450 lbs  32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0801002004pounds                                                                                                                                                                                                                                                                                                               
K0802001003Power operated vehicle, group 1 very heavy duty, patient weight capacity 451 to Pov group 1 vhd 451-600 lbs 32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0802002004600 pounds                                                                                                                                                                                                                                                                                                           
K0806001003Power operated vehicle, group 2 standard, patient weight capacity up to and     Pov group 2 std up to 300lbs32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0806002004including 300 pounds                                                                                                                                                                                                                                                                                                 
K0807001003Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450  Pov group 2 hd 301-450 lbs  32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0807002004pounds                                                                                                                                                                                                                                                                                                               
K0808001003Power operated vehicle, group 2 very heavy duty, patient weight capacity 451 to Pov group 2 vhd 451-600 lbs 32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0808002004600 pounds                                                                                                                                                                                                                                                                                                           
K0812001003Power operated vehicle, not otherwise classified                                Power operated vehicle noc  32      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0813001003Power wheelchair, group 1 standard, portable, sling/solid seat and back,        Pwc gp 1 std port seat/back 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0813002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0814001003Power wheelchair, group 1 standard, portable, captains chair, patient weight    Pwc gp 1 std port cap chair 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0814002004capacity up to and including 300 pounds                                                                                                                                                                                                                                                                              
K0815001003Power wheelchair, group 1 standard, sling/solid seat and back, patient weight   Pwc gp 1 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0815002004capacity up to and including 300 pounds                                                                                                                                                                                                                                                                              
K0816001003Power wheelchair, group 1 standard, captains chair, patient weight capacity up  Pwc gp 1 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0816002004to and including 300 pounds                                                                                                                                                                                                                                                                                          
K0820001003Power wheelchair, group 2 standard, portable, sling/solid seat/back, patient    Pwc gp 2 std port seat/back 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0820002004weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                                       
K0821001003Power wheelchair, group 2 standard, portable, captains chair, patient weight    Pwc gp 2 std port cap chair 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0821002004capacity up to and including 300 pounds                                                                                                                                                                                                                                                                              
K0822001003Power wheelchair, group 2 standard, sling/solid seat/back, patient weight       Pwc gp 2 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0822002004capacity up to and including 300 pounds                                                                                                                                                                                                                                                                              
K0823001003Power wheelchair, group 2 standard, captains chair, patient weight capacity up  Pwc gp 2 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0823002004to and including 300 pounds                                                                                                                                                                                                                                                                                          
K0824001003Power wheelchair, group 2 heavy duty, sling/solid seat/back, patient weight     Pwc gp 2 hd seat/back       36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0824002004capacity 301 to 450 pounds                                                                                                                                                                                                                                                                                           
K0825001003Power wheelchair, group 2 heavy duty, captains chair, patient weight capacity   Pwc gp 2 hd cap chair       36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0825002004301 to 450 pounds                                                                                                                                                                                                                                                                                                    
K0826001003Power wheelchair, group 2 very heavy duty, sling/solid seat/back, patient       Pwc gp 2 vhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0826002004weight capacity 451 to 600 pounds                                                                                                                                                                                                                                                                                    
K0827001003Power wheelchair, group 2 very heavy duty, captains chair, patient weight       Pwc gp vhd cap chair        36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0827002004capacity 451 to 600 pounds                                                                                                                                                                                                                                                                                           
K0828001003Power wheelchair, group 2 extra heavy duty, sling/solid seat/back, patient      Pwc gp 2 xtra hd seat/back  36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0828002004weight capacity 601 pounds or more                                                                                                                                                                                                                                                                                   
K0829001003Power wheelchair, group 2 extra heavy duty, captains chair, patient weight 601  Pwc gp 2 xtra hd cap chair  36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0829002004pounds or more                                                                                                                                                                                                                                                                                                       
K0830001003Power wheelchair, group 2 standard, seat elevator, sling/solid seat/back,       Pwc gp2 std seat elevate s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0830002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0831001003Power wheelchair, group 2 standard, seat elevator, captains chair, patient      Pwc gp2 std seat elevate cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0831002004weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                                       
K0835001003Power wheelchair, group 2 standard, single power option, sling/solid seat/back, Pwc gp2 std sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0835002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0836001003Power wheelchair, group 2 standard, single power option, captains chair,        Pwc gp2 std sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0836002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0837001003Power wheelchair, group 2 heavy duty, single power option, sling/solid          Pwc gp 2 hd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0837002004seat/back, patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                 
K0838001003Power wheelchair, group 2 heavy duty, single power option, captains chair,      Pwc gp 2 hd sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0838002004patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                            
K0839001003Power wheelchair, group 2 very heavy duty, single power option, sling/solid     Pwc gp2 vhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0839002004seat/back, patient weight capacity 451 to 600 pounds                                                                                                                                                                                                                                                                 
K0840001003Power wheelchair, group 2 extra heavy duty, single power option, sling/solid    Pwc gp2 xhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0840002004seat/back, patient weight capacity 601 pounds or more                                                                                                                                                                                                                                                                
K0841001003Power wheelchair, group 2 standard, multiple power option, sling/solid          Pwc gp2 std mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0841002004seat/back, patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                    
K0842001003Power wheelchair, group 2 standard, multiple power option, captains chair,      Pwc gp2 std mult pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0842002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0843001003Power wheelchair, group 2 heavy duty, multiple power option, sling/solid        Pwc gp2 hd mult pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0843002004seat/back, patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                 
K0848001003Power wheelchair, group 3 standard, sling/solid seat/back, patient weight       Pwc gp 3 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0848002004capacity up to and including 300 pounds                                                                                                                                                                                                                                                                              
K0849001003Power wheelchair, group 3 standard, captains chair, patient weight capacity up  Pwc gp 3 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0849002004to and including 300 pounds                                                                                                                                                                                                                                                                                          
K0850001003Power wheelchair, group 3 heavy duty, sling/solid seat/back, patient weight     Pwc gp 3 hd seat/back       36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0850002004capacity 301 to 450 pounds                                                                                                                                                                                                                                                                                           
K0851001003Power wheelchair, group 3 heavy duty, captains chair, patient weight capacity   Pwc gp 3 hd cap chair       36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0851002004301 to 450 pounds                                                                                                                                                                                                                                                                                                    
K0852001003Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient       Pwc gp 3 vhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0852002004weight capacity 451 to 600 pounds                                                                                                                                                                                                                                                                                    
K0853001003Power wheelchair, group 3 very heavy duty, captains chair, patient weight       Pwc gp 3 vhd cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0853002004capacity 451 to 600 pounds                                                                                                                                                                                                                                                                                           
K0854001003Power wheelchair, group 3 extra heavy duty, sling/solid seat/back, patient      Pwc gp 3 xhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0854002004weight capacity 601 pounds or more                                                                                                                                                                                                                                                                                   
K0855001003Power wheelchair, group 3 extra heavy duty, captains chair, patient weight      Pwc gp 3 xhd cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0855002004capacity 601 pounds or more                                                                                                                                                                                                                                                                                          
K0856001003Power wheelchair, group 3 standard, single power option, sling/solid seat/back, Pwc gp3 std sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0856002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0857001003Power wheelchair, group 3 standard, single power option, captains chair,        Pwc gp3 std sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0857002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0858001003Power wheelchair, group 3 heavy duty, single power option, sling/solid          Pwc gp3 hd sing pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0858002004seat/back, patient weight 301 to 450 pounds                                                                                                                                                                                                                                                                          
K0859001003Power wheelchair, group 3 heavy duty, single power option, captains chair,      Pwc gp3 hd sing pow opt cap 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0859002004patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                            
K0860001003Power wheelchair, group 3 very heavy duty, single power option, sling/solid     Pwc gp3 vhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0860002004seat/back, patient weight capacity 451 to 600 pounds                                                                                                                                                                                                                                                                 
K0861001003Power wheelchair, group 3 standard, multiple power option, sling/solid          Pwc gp3 std mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0861002004seat/back, patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                    
K0862001003Power wheelchair, group 3 heavy duty, multiple power option, sling/solid        Pwc gp3 hd mult pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0862002004seat/back, patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                 
K0863001003Power wheelchair, group 3 very heavy duty, multiple power option, sling/solid   Pwc gp3 vhd mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0863002004seat/back, patient weight capacity 451 to 600 pounds                                                                                                                                                                                                                                                                 
K0864001003Power wheelchair, group 3 extra heavy duty, multiple power option, sling/solid  Pwc gp3 xhd mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0864002004seat/back, patient weight capacity 601 pounds or more                                                                                                                                                                                                                                                                
K0868001003Power wheelchair, group 4 standard, sling/solid seat/back, patient weight       Pwc gp 4 std seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0868002004capacity up to and including 300 pounds                                                                                                                                                                                                                                                                              
K0869001003Power wheelchair, group 4 standard, captains chair, patient weight capacity up  Pwc gp 4 std cap chair      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0869002004to and including 300 pounds                                                                                                                                                                                                                                                                                          
K0870001003Power wheelchair, group 4 heavy duty, sling/solid seat/back, patient weight     Pwc gp 4 hd seat/back       36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0870002004capacity 301 to 450 pounds                                                                                                                                                                                                                                                                                           
K0871001003Power wheelchair, group 4 very heavy duty, sling/solid seat/back, patient       Pwc gp 4 vhd seat/back      36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0871002004weight capacity 451 to 600 pounds                                                                                                                                                                                                                                                                                    
K0877001003Power wheelchair, group 4 standard, single power option, sling/solid seat/back, Pwc gp4 std sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0877002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0878001003Power wheelchair, group 4 standard, single power option, captains chair,        Pwc gp4 std sing pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0878002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0879001003Power wheelchair, group 4 heavy duty, single power option, sling/solid          Pwc gp4 hd sing pow opt s/b 36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0879002004seat/back, patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                 
K0880001003Power wheelchair, group 4 very heavy duty, single power option, sling/solid     Pwc gp4 vhd sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0880002004seat/back, patient weight 451 to 600 pounds                                                                                                                                                                                                                                                                          
K0884001003Power wheelchair, group 4 standard, multiple power option, sling/solid          Pwc gp4 std mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0884002004seat/back, patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                    
K0885001003Power wheelchair, group 4 standard, multiple power option, captains chair,      Pwc gp4 std mult pow opt cap36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0885002004patient weight capacity up to and including 300 pounds                                                                                                                                                                                                                                                               
K0886001003Power wheelchair, group 4 heavy duty, multiple power option, sling/solid        Pwc gp4 hd mult pow s/b     36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0886002004seat/back, patient weight capacity 301 to 450 pounds                                                                                                                                                                                                                                                                 
K0890001003Power wheelchair, group 5 pediatric, single power option, sling/solid           Pwc gp5 ped sing pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0890002004seat/back, patient weight capacity up to and including 125 pounds                                                                                                                                                                                                                                                    
K0891001003Power wheelchair, group 5 pediatric, multiple power option, sling/solid         Pwc gp5 ped mult pow opt s/b36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0891002004seat/back, patient weight capacity up to and including 125 pounds                                                                                                                                                                                                                                                    
K0898001003Power wheelchair, not otherwise classified                                      Power wheelchair noc        36      A                                                                                                     C                          D1D APR    02006100120061001        N                           
K0899001003Power mobility device, not coded by dme pdac or does not meet criteria          Pow mobil dev no dmepdac    00      9                                                                                                     C                          D1D APR    02006100120160101        N                           
K0900001003Customized durable medical equipment, other than wheelchair                     Cstm dme other than wheelchr45      A                                                                                                     D                      0188D1E APR    02013070120130701        N                           
K0901001003Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and Ko single upright pre ots   38      A                                                                            L1851                    C                          D1F P      0201410012017010120161231N                           
K0901002004extension joint (unicentric or polycentric), medial-lateral and rotation                                                                                                                                                                                                                                             
K0901003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf                                                                                                                                                                                                                                       
K0902001003Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and Ko double upright pre ots   38      A                                                                            L1852                    C                          D1F P      0201410012017010120161231N                           
K0902002004extension joint (unicentric or polycentric), medial-lateral and rotation                                                                                                                                                                                                                                             
K0902003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf                                                                                                                                                                                                                                       
K0903001003For diabetics only, multiple density insert, made by direct carving with cam    Mult den insert dir carv/cam38      A                                                                                                     C                          D1F J      0201804012019010120181231D                           
K0903002004technology from a rectified cad model created from a digitized scan of the                                                                                                                                                                                                                                           
K0903003004patient, total contact with patient's foot, including arch, base layer minimum                                                                                                                                                                                                                                       
K0903004004of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler                                                                                                                                                                                                                                      
K0903005004and other shaping material, custom fabricated, each                                                                                                                                                                                                                                                                  
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                                                                                                                                                                                                                                              
L0113001003Cranial cervical orthosis, torticollis type, with or without joint, with or     Cranial cervical torticollis38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L0113002004without soft interface material, prefabricated, includes fitting and adjustment                                                                                                                                                                                                                                      
L0120001003Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)  Cerv flex n/adj foam pre ots38      A                                                                                                     C                          D1F P      01982010120140101        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, prefabricated,   Cerv sr wire occ/man pre ots38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L0160002004off-the-shelf                                                                                                                                                                                                                                                                                                        
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, prefabricated,      Cerv col sr foam 2pc pre ots38      A                                                                                                     C                          D1F P      01988010120140101        N                           
L0172002004off-the-shelf                                                                                                                                                                                                                                                                                                        
L0174001003Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic       Cerv sr 2pc thor ext pre ots38      A                                                                                                     C                          D1F P      01988010120140101        N                           
L0174002004extension, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                              
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                                                                                                                                                                                                                                                                                
L0220001003Thoracic, rib belt, custom fabricated                                           Thor rib belt custom fabrica38      A                                                                                                     C                          D1F P      01982010119960101        N                           
L0450001003Tlso, flexible, provides trunk support, upper thoracic region, produces         Tlso flex trunk/thor pre ots38      A                                                                                                     C                          D1F P      02003010120140101        N                           
L0450002004intracavitary pressure to reduce load on the intervertebral disks with rigid                                                                                                                                                                                                                                         
L0450003004stays or panel(s), includes shoulder straps and closures, prefabricated,                                                                                                                                                                                                                                             
L0450004004off-the-shelf                                                                                                                                                                                                                                                                                                        
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 trnk sj-t9 pre cst     38      A                                                                                                     C                          D1F P      02003010120140101        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                                                                                                                                                                                                                                        
L0454005004item that has been trimmed, bent, molded, assembled, or otherwise customized to                                                                                                                                                                                                                                      
L0454006004fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                               
L0455001003Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to Tlso flex trnk sj-t9 pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0455002004above t-9 vertebra, restricts gross trunk motion in the sagittal plane,                                                                                                                                                                                                                                              
L0455003004produces intracavitary pressure to reduce load on the intervertebral disks with                                                                                                                                                                                                                                      
L0455004004rigid stays or panel(s), includes shoulder straps and closures, prefabricated,                                                                                                                                                                                                                                       
L0455005004off-the-shelf                                                                                                                                                                                                                                                                                                        
L0456001003Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel  Tlso flex trnk sj-ss pre cst38      A                                                                                                     C                          D1F P      02003010120140101        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 item that has                                                                                                                                                                                                                                      
L0456006004been trimmed, bent, molded, assembled, or otherwise customized to fit a                                                                                                                                                                                                                                              
L0456007004specific patient by an individual with expertise                                                                                                                                                                                                                                                                     
L0457001003Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel  Tlso flex trnk sj-ss pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0457002004and soft anterior apron, extends from the sacrococcygeal junction and                                                                                                                                                                                                                                                
L0457003004terminates just inferior to the scapular spine, restricts gross trunk motion in                                                                                                                                                                                                                                      
L0457004004the sagittal plane, produces intracavitary pressure to reduce load on the                                                                                                                                                                                                                                            
L0457005004intervertebral disks, includes straps and closures, prefabricated, off-the-shelf                                                                                                                                                                                                                                     
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 transverse 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     Tlso 2 shl symphys-stern cst38      A                                                                                                     C                          D1F P      02003010120140101        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 transverse planes, lateral strength is provided by overlapping                                                                                                                                                                                                                                          
L0460006004plastic and stabilizing closures, includes straps and closures, prefabricated                                                                                                                                                                                                                                        
L0460007004item that has been trimmed, bent, molded, assembled, or otherwise customized to                                                                                                                                                                                                                                      
L0460008004fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                               
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 transverse 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 r fram soft ant pre cst38      A                                                                                                     C                          D1F P      02003010120140101        N                           
L0466002004with straps, closures and padding, restricts gross trunk motion in sagittal                                                                                                                                                                                                                                          
L0466003004plane, produces intracavitary pressure to reduce load on intervertebral disks,                                                                                                                                                                                                                                       
L0466004004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L0466005004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L0467001003Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron  Tlso r fram soft pre ots    38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0467002004with straps, closures and padding, restricts gross trunk motion in sagittal                                                                                                                                                                                                                                          
L0467003004plane, produces intracavitary pressure to reduce load on intervertebral disks,                                                                                                                                                                                                                                       
L0467004004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L0468001003Tlso, sagittal-coronal control, rigid posterior frame and flexible soft         Tlso rig fram pelvic pre cst38      A                                                                                                     C                          D1F P      02003010120140101        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,                                                                                                                                                                                                                                      
L0468006004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L0468007004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L0469001003Tlso, sagittal-coronal control, rigid posterior frame and flexible soft         Tlso rig fram pelvic pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0469002004anterior apron with straps, closures and padding, extends from sacrococcygeal                                                                                                                                                                                                                                        
L0469003004junction over scapulae, lateral strength provided by pelvic, thoracic, and                                                                                                                                                                                                                                           
L0469004004lateral frame pieces, restricts gross trunk motion in sagittal and coronal                                                                                                                                                                                                                                           
L0469005004planes, produces intracavitary pressure to reduce load on intervertebral disks,                                                                                                                                                                                                                                      
L0469006004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
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 transverse planes, provides                                                                                                                                                                                                                                             
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                                                                                                                                                                                                                                                                                      
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        N                           
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        N                           
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                                                                                                                                                                                                                                                                                      
L0621001003Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion   Sio flex pelvic/sacr pre ots38      A                                                                                                     C                          D1F P      02006010120140101        N                           
L0621002004about the sacroiliac joint, includes straps, closures, may include pendulous                                                                                                                                                                                                                                         
L0621003004abdomen design, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                         
L0622001003Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion   Sio flex pelvisacral custom 38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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 rig pnl pelv/sac pre ots38      A                                                                                                     C                          D1F P      02006010120140101        N                           
L0623002004panels over the sacrum and abdomen, reduces motion about the sacroiliac joint,                                                                                                                                                                                                                                       
L0623003004includes straps, closures, may include pendulous abdomen design, prefabricated,                                                                                                                                                                                                                                      
L0623004004off-the-shelf                                                                                                                                                                                                                                                                                                        
L0624001003Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid   Sio panel custom            38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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 flex l1-below l5 pre ots 38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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, off-the-shelf                                                                                                                                                                                                                                                         
L0626001003Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior     Lo sag rig pnl stays pre cst38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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 item                                                                                                                                                                                                                                        
L0626005004that has been trimmed, bent, molded, assembled, or otherwise customized to fit                                                                                                                                                                                                                                       
L0626006004a specific patient by an individual with expertise                                                                                                                                                                                                                                                                   
L0627001003Lumbar orthosis, sagittal control, with rigid anterior and posterior panels,    Lo sag ri an/pos pnl pre cst38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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                                                                                                                                                                                                                                        
L0627005004item that has been trimmed, bent, molded, assembled, or otherwise customized to                                                                                                                                                                                                                                      
L0627006004fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                               
L0628001003Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior      Lso flex no ri stays pre ots38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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,                                                                                                                                                                                                                                         
L0628005004off-the-shelf                                                                                                                                                                                                                                                                                                        
L0629001003Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior      Lso flex w/rigid stays cust 38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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 r post pnl sj-t9 pre cst38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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 item that has been trimmed, bent, molded,                                                                                                                                                                                                                                              
L0630006004assembled, or otherwise customized to fit a specific patient by an individual                                                                                                                                                                                                                                        
L0630007004with expertise                                                                                                                                                                                                                                                                                                       
L0631001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior     Lso sag r an/pos pnl pre cst38      A                                                                                                     C                          D1F P      02006010120140101        N                           
L0631002004panels, posterior extends from sacrococcygeal junction to t-9 vertebra,                                                                                                                                                                                                                                              
L0631003004produces intracavitary pressure to reduce load on the intervertebral discs,                                                                                                                                                                                                                                          
L0631004004includes straps, closures, may include padding, shoulder straps, pendulous                                                                                                                                                                                                                                           
L0631005004abdomen design, prefabricated item that has been trimmed, bent, molded,                                                                                                                                                                                                                                              
L0631006004assembled, or otherwise customized to fit a specific patient by an individual                                                                                                                                                                                                                                        
L0631007004with expertise                                                                                                                                                                                                                                                                                                       
L0632001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior     Lso sag rigid frame cust    38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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 sc r pos/lat pnl pre cst38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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 item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L0633007004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L0634001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior          Lso flexion control custom  38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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        N                           
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        N                           
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 sc r ant/pos pnl pre cst38      A                                                                                                     C                          D1F P      02006010120140101        N                           
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 item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L0637007004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L0638001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and       Lso sag-coronal panel custom38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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      02006010120140101        N                           
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 item that                                                                                                                                                                                                                                        
L0639007004has been trimmed, bent, molded, assembled, or otherwise customized to fit a                                                                                                                                                                                                                                          
L0639008004specific patient by an individual with expertise                                                                                                                                                                                                                                                                     
L0640001003Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s),      Lso s/c shell/panel custom  38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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                                                                                                                                                                                                                                              
L0641001003Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior     Lo rig pos pnl l1-l5 pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0641002004extends from l-1 to below l-5 vertebra, produces intracavitary pressure to                                                                                                                                                                                                                                           
L0641003004reduce load on the intervertebral discs, includes straps, closures, may include                                                                                                                                                                                                                                      
L0641004004padding, stays, shoulder straps, pendulous abdomen design, prefabricated,                                                                                                                                                                                                                                            
L0641005004off-the-shelf                                                                                                                                                                                                                                                                                                        
L0642001003Lumbar orthosis, sagittal control, with rigid anterior and posterior panels,    Lo sag ri an/pos pnl pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0642002004posterior extends from l-1 to below l-5 vertebra, produces intracavitary                                                                                                                                                                                                                                             
L0642003004pressure to reduce load on the intervertebral discs, includes straps, closures,                                                                                                                                                                                                                                      
L0642004004may include padding, shoulder straps, pendulous abdomen design, prefabricated,                                                                                                                                                                                                                                       
L0642005004off-the-shelf                                                                                                                                                                                                                                                                                                        
L0643001003Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s),        Lso sag ctr rigi pos pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0643002004posterior extends from sacrococcygeal junction to t-9 vertebra, produces                                                                                                                                                                                                                                             
L0643003004intracavitary pressure to reduce load on the intervertebral discs, includes                                                                                                                                                                                                                                          
L0643004004straps, closures, may include padding, stays, shoulder straps, pendulous                                                                                                                                                                                                                                             
L0643005004abdomen design, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                         
L0648001003Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior     Lso sag r an/pos pnl pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0648002004panels, posterior extends from sacrococcygeal junction to t-9 vertebra,                                                                                                                                                                                                                                              
L0648003004produces intracavitary pressure to reduce load on the intervertebral discs,                                                                                                                                                                                                                                          
L0648004004includes straps, closures, may include padding, shoulder straps, pendulous                                                                                                                                                                                                                                           
L0648005004abdomen design, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                         
L0649001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior          Lso sc r pos/lat pnl pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0649002004frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra,                                                                                                                                                                                                                                      
L0649003004lateral strength provided by rigid lateral frame/panels, produces intracavitary                                                                                                                                                                                                                                      
L0649004004pressure to reduce load on intervertebral discs, includes straps, closures, may                                                                                                                                                                                                                                      
L0649005004include padding, stays, shoulder straps, pendulous abdomen design,                                                                                                                                                                                                                                                   
L0649006004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L0650001003Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and       Lso sc r ant/pos pnl pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0650002004posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9                                                                                                                                                                                                                                      
L0650003004vertebra, lateral strength provided by rigid lateral frame/panel(s), produces                                                                                                                                                                                                                                        
L0650004004intracavitary pressure to reduce load on intervertebral discs, includes straps,                                                                                                                                                                                                                                      
L0650005004closures, may include padding, shoulder straps, pendulous abdomen design,                                                                                                                                                                                                                                            
L0650006004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L0651001003Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s),      Lso sag-co shell pnl pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L0651002004posterior extends from sacrococcygeal junction to t-9 vertebra, anterior                                                                                                                                                                                                                                             
L0651003004extends from symphysis pubis to xyphoid, produces intracavitary pressure to                                                                                                                                                                                                                                          
L0651004004reduce load on the intervertebral discs, overall strength is provided by                                                                                                                                                                                                                                             
L0651005004overlapping rigid material and stabilizing closures, includes straps, closures,                                                                                                                                                                                                                                      
L0651006004may include soft interface, pendulous abdomen design, prefabricated,                                                                                                                                                                                                                                                 
L0651007004off-the-shelf                                                                                                                                                                                                                                                                                                        
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      01986010119860101        N                           
L0820001003Halo procedure, cervical halo incorporated into plaster body jacket             Halo cervical into body jack38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L0830001003Halo procedure, cervical halo incorporated into milwaukee type orthosis         Halo cerv into milwaukee typ38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L0859001003Addition to halo procedure, magnetic resonance image compatible systems, rings  Mri compatible system       38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L0859002004and pins, any material                                                                                                                                                                                                                                                                                               
L0861001003Addition to halo procedure, replacement liner/interface material                Halo repl liner/interface   38      A                                                                                                     C                          D1F P      02004010120040101        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, prefabricated, off-the-shelf, pair                             Peroneal straps pair pre ots38      A                                                                                                     C                          D1F P      01986010120140101        N                           
L0982001003Stocking supporter grips, prefabricated, off-the-shelf, set of four (4)         Stocking sup grips 4 pre ots38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L0984001003Protective body sock, prefabricated, off-the-shelf, each                        Protect body sock ea pre ots38      A                                                                                                     C                          D1F P      01994010120140101        N                           
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                                                                                                                                                                                                                                                                         
L1001001003Cervical thoracic lumbar sacral orthosis, immobilizer, infant size,             Ctlso infant immobilizer    38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L1001002004prefabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                       
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      01986010119860101        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      01986010119860101        N                           
L1499001003Spinal orthosis, not otherwise specified                                        Spinal orthosis nos         46      A                                                                                                     C                          D1F P      01982010119980101        N                           
L1600001003Hip orthosis, abduction control of hip joints, flexible, frejka type with       Ho flex frejka w/cov pre cst38      A                                                                                                     C                          D1F P      01986010120140101        N                           
L1600002004cover, prefabricated item that has been trimmed, bent, molded, assembled, or                                                                                                                                                                                                                                         
L1600003004otherwise customized to fit a specific patient by an inidividual with expertise                                                                                                                                                                                                                                      
L1610001003Hip orthosis, abduction control of hip joints, flexible, (frejka cover only),   Ho frejka cov only pre cst  38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L1610002004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L1610003004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L1620001003Hip orthosis, abduction control of hip joints, flexible, (pavlik harness),      Ho flex pavlik harns pre cst38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L1620002004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L1620003004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
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                           
L1755001003Legg perthes orthosis, (patten bottom type), custom fabricated                  Legg perthes patten bottom t38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L1810001003Knee orthosis, elastic with joints, prefabricated item that has been trimmed,   Ko elastic with joints      38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L1810002004bent, molded, assembled, or otherwise customized to fit a specific patient by                                                                                                                                                                                                                                        
L1810003004an individual with expertise                                                                                                                                                                                                                                                                                         
L1812001003Knee orthosis, elastic with joints, prefabricated, off-the-shelf                Ko elastic w/joints pre ots 38      A                                                                                                     C                          D1F P      02014010120140101        N                           
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                                                                                                                                                                                                                                                              
L1830001003Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf   Ko immob canvas long pre ots38      A                                                                                                     C                          D1F P      01986010120140101        N                           
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 r sup pre cst38      A                                                                                                     C                          D1F P      01989010120140101        N                           
L1832002004orthosis, rigid support, prefabricated item that has been trimmed, bent,                                                                                                                                                                                                                                             
L1832003004molded, assembled, or otherwise customized to fit a specific patient by an                                                                                                                                                                                                                                           
L1832004004individual with expertise                                                                                                                                                                                                                                                                                            
L1833001003Knee orthosis, adjustable knee joints (unicentric or polycentric), positional   Ko adj jnt pos r sup pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L1833002004orthosis, rigid support, prefabricated, off-the shelf                                                                                                                                                                                                                                                                
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,       Ko rigid w/o joints pre ots 38      A                                                                                                     C                          D1F P      02003010120140101        N                           
L1836002004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
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 pre cst   38      A                                                                                                     C                          D1F P      01998010120140101        N                           
L1843002004extension joint (unicentric or polycentric), medial-lateral and rotation                                                                                                                                                                                                                                             
L1843003004control, with or without varus/valgus adjustment, prefabricated item that has                                                                                                                                                                                                                                        
L1843004004been trimmed, bent, molded, assembled, or otherwise customized to fit a                                                                                                                                                                                                                                              
L1843005004specific patient by an individual with expertise                                                                                                                                                                                                                                                                     
L1844001003Knee orthosis, single upright, thigh and calf, with adjustable flexion and      Ko w/adj jt rot cntrl molded38      A                                                                                                     C                          D1F P      01993010120060101        N                           
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 double upright pre cst   38      A                                                                                                     C                          D1F P      01988010120140101        N                           
L1845002004extension joint (unicentric or polycentric), medial-lateral and rotation                                                                                                                                                                                                                                             
L1845003004control, with or without varus/valgus adjustment, prefabricated item that has                                                                                                                                                                                                                                        
L1845004004been trimmed, bent, molded, assembled, or otherwise customized to fit a                                                                                                                                                                                                                                              
L1845005004specific patient by an individual with expertise                                                                                                                                                                                                                                                                     
L1846001003Knee orthosis, double upright, thigh and calf, with adjustable flexion and      Ko w adj flex/ext rotat mold38      A                                                                                                     C                          D1F P      01988010120060101        N                           
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 dbl upright w/air pre cst38      A                                                                                                     C                          D1F P      01999010120140101        N                           
L1847002004support chamber(s), prefabricated item that has been trimmed, bent, molded,                                                                                                                                                                                                                                          
L1847003004assembled, or otherwise customized to fit a specific patient by an individual                                                                                                                                                                                                                                        
L1847004004with expertise                                                                                                                                                                                                                                                                                                       
L1848001003Knee orthosis, double upright with adjustable joint, with inflatable air        Ko dbl upright w/air pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L1848002004support chamber(s), prefabricated, off-the-shelf                                                                                                                                                                                                                                                                     
L1850001003Knee orthosis, swedish type, prefabricated, off-the-shelf                       Ko swedish type pre ots     38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L1851001003Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and Ko single upright prefab ots38      A                                                                                                     C                          D1F P      02017010120170101        N                           
L1851002004extension joint (unicentric or polycentric), medial-lateral and rotation                                                                                                                                                                                                                                             
L1851003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf                                                                                                                                                                                                                                       
L1852001003Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and Ko double upright prefab ots38      A                                                                                                     C                          D1F P      02017010120170101        N                           
L1852002004extension joint (unicentric or polycentric), medial-lateral and rotation                                                                                                                                                                                                                                             
L1852003004control, with or without varus/valgus adjustment, prefabricated, off-the-shelf                                                                                                                                                                                                                                       
L1860001003Knee orthosis, modification of supracondylar prosthetic socket, custom          Ko supracondylar socket mold38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L1860002004fabricated (sk)                                                                                                                                                                                                                                                                                                      
L1900001003Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom         Afo sprng wir drsflx calf bd38      A                                                                                                     C                          D1F P      01986010120010101        N                           
L1900002004fabricated                                                                                                                                                                                                                                                                                                           
L1902001003Ankle orthosis, ankle gauntlet or similar, with or without joints,              Afo ankle gauntlet pre ots  38      A                                                                                                     C                          D1F P      01988010120160101        N                           
L1902002004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L1904001003Ankle orthosis, ankle gauntlet or similar, with or without joints, custom       Afo molded ankle gauntlet   38      A                                                                                                     C                          D1F P      01988010120160101        N                           
L1904002004fabricated                                                                                                                                                                                                                                                                                                           
L1906001003Ankle foot orthosis, multiligamentous ankle support, prefabricated,             Afo multilig ank sup pre ots38      A                                                                                                     C                          D1F P      01988010120170101        N                           
L1906002004off-the-shelf                                                                                                                                                                                                                                                                                                        
L1907001003Ankle orthosis, supramalleolar with straps, with or without interface/pads,     Afo supramalleolar custom   38      A                                                                                                     C                          D1F P      02004010120140101        N                           
L1907002004custom fabricated                                                                                                                                                                                                                                                                                                    
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      02005010120120101        N                           
L2005002004control, automatic lock and swing phase release, any type activation, includes                                                                                                                                                                                                                                       
L2005003004ankle 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, custom                                                                                                                                                                                                                                              
L2010003004fabricated                                                                                                                                                                                                                                                                                                           
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        N                           
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        N                           
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        N                           
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        N                           
L2038002004multi-axis ankle, custom fabricated                                                                                                                                                                                                                                                                                  
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                                                                                                                                                                                                                                                              
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, custom   Afo tib fx cast molded to pt38      A                                                                                                     C                          D1F P      01988010120010101        N                           
L2108002004fabricated                                                                                                                                                                                                                                                                                                           
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                                                                                                                                                                                                                                                                       
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      01986010119860101        N                           
L2250002004attachment                                                                                                                                                                                                                                                                                                           
L2260001003Addition to lower extremity, reinforced solid stirrup (scott-craig type)        Reinforced solid stirrup    38      A                                                                                                     C                          D1F P      01986010119860101        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      01986010119860101        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      01986010119860101        N                           
L2300001003Addition to lower extremity, abduction bar (bilateral hip involvement),         Abduction bar jointed adjust38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L2300002004jointed, adjustable                                                                                                                                                                                                                                                                                                  
L2310001003Addition to lower extremity, abduction bar-straight                             Abduction bar-straight      38      A                                                                                                     C                          D1F P      01986010119860101        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      01988010119880101        N                           
L2340001003Addition to lower extremity, pre-tibial shell, molded to patient model          Pre-tibial shell molded to p38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L2350001003Addition to lower extremity, prosthetic type, (bk) socket, molded to patient    Prosthetic type socket molde38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L2350002004model, (used for 'ptb' 'afo' orthoses)                                                                                                                                                                                                                                                                               
L2360001003Addition to lower extremity, extended steel shank                               Extended steel shank        38      A                                                                                                     C                          D1F P      01986010119860101        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 stirrupTorsion ank & half solid sti38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L2380001003Addition to lower extremity, torsion control, straight knee joint, each joint   Torsion straight knee joint 38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L2385001003Addition to lower extremity, straight knee joint, heavy duty, each joint        Straight knee joint heavy du38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L2387001003Addition to lower extremity, polycentric knee joint, for custom fabricated knee Add le poly knee custom kafo38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L2387002004ankle foot orthosis, each joint                                                                                                                                                                                                                                                                                      
L2390001003Addition to lower extremity, offset knee joint, each joint                      Offset knee joint each      38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L2395001003Addition to lower extremity, offset knee joint, heavy duty, each joint          Offset knee joint heavy duty38      A                                                                                                     C                          D1F P      01988010119880101        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        N                           
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                                                                                                                                                                                                                                                                                                           
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, custom Th/wght bear quad-lat brim c38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L2520002004fitted                                                                                                                                                                                                                                                                                                               
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      01986010119860101        N                           
L2540001003Addition to lower extremity, thigh/weight bearing, lacer, molded to patient     Thigh/wght bear lacer molded38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L2540002004model                                                                                                                                                                                                                                                                                                                
L2550001003Addition to lower extremity, thigh/weight bearing, high roll cuff               Thigh/wght bear high roll cu38      A                                                                                                     C                          D1F P      01986010119860101        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                           
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                                                                                                                                                                                                                                                                                                                 
L2861001003Addition to lower extremity joint, knee or ankle, concentric adjustable torsion Torsion mechanism knee/ankle00      9                                                                                                     I                          D1F P      02010010120100101        N                           
L2861002004style mechanism for custom fabricated orthotics only, 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        N                           
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, prefabricated, off-the-shelf                Hallus-valgus nt dyn pre ots00      9                  2323                                                                               D                          D1F P      01985010120140101        N                           
L3140001003Foot, abduction rotation bar, including shoes                                   Abduction rotation bar shoe 00      9                  2323                                                                               D                          D1F P      01982010119970101        N                           
L3150001003Foot, abduction rotation 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, prefabricated,               Foot plas heel stabi pre ots00      9                  2323                                                                               D                          D1F P      01984010120140101        N                           
L3170002004off-the-shelf, each                                                                                                                                                                                                                                                                                                  
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        N                           
L3216001003Orthopedic footwear, ladies shoe, depth inlay, each                             Orthoped ladies shoes dpth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N                           
L3217001003Orthopedic footwear, ladies shoe, hightop, depth inlay, each                    Ladies shoes hightop depth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N                           
L3219001003Orthopedic footwear, mens shoe, oxford, each                                    Orthopedic mens shoes oxford00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N                           
L3221001003Orthopedic footwear, mens shoe, depth inlay, each                               Orthopedic mens shoes dpth i00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N                           
L3222001003Orthopedic footwear, mens shoe, hightop, depth inlay, each                      Mens shoes hightop depth inl00      9                                          1862A8                                                     S                          D1F P      01984010120060101        N                           
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        N                           
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,  So 8 abd restraint pre ots  38      A                                                                                                     C                          D1F P      01986010120140101        N                           
L3650002004off-the-shelf                                                                                                                                                                                                                                                                                                        
L3660001003Shoulder orthosis, figure of eight design abduction restrainer, canvas and      So 8 ab rstr can/web pre ots38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L3660002004webbing, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                
L3670001003Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, So acro/clav can web pre ots38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L3670002004off-the-shelf                                                                                                                                                                                                                                                                                                        
L3671001003Shoulder orthosis, shoulder joint design, without joints, may include soft      So cap design w/o jnts cf   38      A                                                                                                     C                          D1F P      02006010120110101        N                           
L3671002004interface, straps, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                
L3674001003Shoulder orthosis, abduction positioning (airplane design), thoracic component  So airplane w/wo joint cf   38      A                                                                                                     C                          D1F P      02011010120110101        N                           
L3674002004and support bar, with or without nontorsion joint/turnbuckle, may include soft                                                                                                                                                                                                                                       
L3674003004interface, straps, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                
L3675001003Shoulder orthosis, vest type abduction restrainer, canvas webbing type or       So vest canvas/web pre ots  38      A                                                                                                     C                          D1F P      01999010120140101        N                           
L3675002004equal, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                  
L3677001003Shoulder orthosis, shoulder joint design, without joints, may include soft      So hard plas stabili pre cst00      9                  2130                                                                               D                          Z2  P      02002010120140101        N                           
L3677002004interface, straps, prefabricated item that has been trimmed, bent, molded,                                                                                                                                                                                                                                           
L3677003004assembled, or otherwise customized to fit a specific patient by an individual                                                                                                                                                                                                                                        
L3677004004with expertise                                                                                                                                                                                                                                                                                                       
L3678001003Shoulder orthosis, shoulder joint design, without joints, may include soft      So hard plas stabili pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L3678002004interface, straps, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                      
L3702001003Elbow orthosis, without joints, may include soft interface, straps, custom      Eo w/o joints cf            38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3702002004fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                          
L3710001003Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf         Eo elas w/metal jnts pre ots38      A                                                                                                     C                          D1F P      01986010120140101        N                           
L3720001003Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom      Forearm/arm cuffs free motio38      A                                                                                                     C                          D1F P      01984010120010101        N                           
L3720002004fabricated                                                                                                                                                                                                                                                                                                           
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 (eo), with adjustable position locking joint(s), prefabricated,  Eo adj jt prefab custom fit 38      A                                                                                                     C                          D1F P      02001010120180101        N                           
L3760002004item that has been trimmed, bent, molded, assembled, or otherwise customized to                                                                                                                                                                                                                                      
L3760003004fit a specific  patient by an individual with expertise                                                                                                                                                                                                                                                              
L3761001003Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated,  Eo, adj lock joint prefab ot38      A                                                                                                     C                          D1F P      02018010120180101        N                           
L3761002004off-the-shelf                                                                                                                                                                                                                                                                                                        
L3762001003Elbow orthosis, rigid, without joints, includes soft interface material,        Eo rigid w/o joints pre ots 38      A                                                                                                     C                          D1F P      02003010120140101        N                           
L3762002004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L3763001003Elbow wrist hand orthosis, rigid, without joints, may include soft interface,   Ewho rigid w/o jnts cf      38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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        N                           
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        N                           
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        N                           
L3766002004elastic bands, turnbuckles, may include soft interface, straps, custom                                                                                                                                                                                                                                               
L3766003004fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                          
L3806001003Wrist hand finger orthosis, includes one or more nontorsion joint(s),           Whfo w/joint(s) custom fab  38      A                                                                                                     C                          D1F P      02007010120080101        N                           
L3806002004turnbuckles, elastic bands/springs, may include soft interface material,                                                                                                                                                                                                                                             
L3806003004straps, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                           
L3807001003Wrist hand finger orthosis, without joint(s), prefabricated item that has been  Whfo w/o joints pre cst     38      A                                                                                                     C                          D1F P      02000010120140101        N                           
L3807002004trimmed, bent, molded, assembled, or otherwise customized to fit a specific                                                                                                                                                                                                                                          
L3807003004patient by an individual with expertise                                                                                                                                                                                                                                                                              
L3808001003Wrist hand finger orthosis, rigid without joints, may include soft interface    Whfo, rigid w/o joints      38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L3808002004material; straps, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                 
L3809001003Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any Whfo w/o joints pre ots     38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L3809002004type                                                                                                                                                                                                                                                                                                                 
L3891001003Addition to upper extremity joint, wrist or elbow, concentric adjustable        Torsion mechanism wrist/elbo00      9                                                                                                     I                          D1F P      02010010120100101        N                           
L3891002004torsion style mechanism for custom fabricated orthotics only, 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                                                                                                                                                                                                                                                   
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        N                           
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        N                           
L3906002004fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                          
L3908001003Wrist hand orthosis, wrist extension control cock-up, non molded,               Who cock-up nonmolde pre ots38      A                                                                                                     C                          D1F P      01986010120140101        N                           
L3908002004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L3912001003Hand finger orthosis (hfo), flexion glove with elastic finger control,          Hfo flexion glove pre ots   38      A                                                                                                     C                          D1F P      01982010120140101        N                           
L3912002004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L3913001003Hand finger orthosis, without joints, may include soft interface, straps,       Hfo w/o joints cf           38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3913002004custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                   
L3915001003Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands,   Who nontorsion jnts pre cst 38      A                                                                                                     C                          D1F P      02007010120140101        N                           
L3915002004turnbuckles, may include soft interface, straps, prefabricated item that has                                                                                                                                                                                                                                         
L3915003004been trimmed, bent, molded, assembled, or otherwise customized to fit a                                                                                                                                                                                                                                              
L3915004004specific patient by an individual with expertise                                                                                                                                                                                                                                                                     
L3916001003Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands,   Who nontorsion jnts pre ots 38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L3916002004turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf                                                                                                                                                                                                                                        
L3917001003Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been   Metacarp fx orthosis pre cst38      A                                                                                                     C                          D1F P      02004010120140101        N                           
L3917002004trimmed, bent, molded, assembled, or otherwise customized to fit a specific                                                                                                                                                                                                                                          
L3917003004patient by an individual with expertise                                                                                                                                                                                                                                                                              
L3918001003Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf       Metacarp fx orthosis pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L3919001003Hand orthosis, without joints, may include soft interface, straps, custom       Ho w/o joints cf            38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3919002004fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                          
L3921001003Hand finger orthosis, includes one or more nontorsion joints, elastic bands,    Hfo w/joint(s) cf           38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3921002004turnbuckles, may include soft interface, straps, custom fabricated, includes                                                                                                                                                                                                                                         
L3921003004fitting and adjustment                                                                                                                                                                                                                                                                                               
L3923001003Hand finger orthosis, without joints, may include soft interface, straps,       Hfo without joints pre cst  38      A                                                                                                     C                          D1F P      02001010120140101        N                           
L3923002004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L3923003004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L3924001003Hand finger orthosis, without joints, may include soft interface, straps,       Hfo without joints pre ots  38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L3924002004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L3925001003Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip),   Fo pip dip jnt/sprng pre ots38      A                                                                                                     C                          D1F P      02008010120140101        N                           
L3925002004non torsion joint/spring, extension/flexion, may include soft interface                                                                                                                                                                                                                                              
L3925003004material, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                               
L3927001003Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip),   Fo pip dip no jt spr pre ots38      A                                                                                                     C                          D1F P      02008010120140101        N                           
L3927002004without joint/spring, extension/flexion (e.g., static or ring type), may                                                                                                                                                                                                                                             
L3927003004include soft interface material, prefabricated, off-the-shelf                                                                                                                                                                                                                                                        
L3929001003Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles,    Hfo nontorsion jnts pre cst 38      A                                                                                                     C                          D1F P      02008010120140101        N                           
L3929002004elastic bands/springs, may include soft interface material, straps,                                                                                                                                                                                                                                                  
L3929003004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L3929004004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L3930001003Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles,    Hfo nontorsion jnts pre ots 38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L3930002004elastic bands/springs, may include soft interface material, straps,                                                                                                                                                                                                                                                  
L3930003004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L3931001003Wrist hand finger orthosis, includes one or more nontorsion joint(s),           Whfo nontorsion joint prefab38      A                                                                                                     C                          D1F P      02008010120080101        N                           
L3931002004turnbuckles, elastic bands/springs, may include soft interface material,                                                                                                                                                                                                                                             
L3931003004straps, prefabricated, includes fitting and adjustment                                                                                                                                                                                                                                                               
L3933001003Finger orthosis, without joints, may include soft interface, custom fabricated, Fo w/o joints cf            38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3933002004includes fitting and adjustment                                                                                                                                                                                                                                                                                      
L3935001003Finger orthosis, nontorsion joint, may include soft interface, custom           Fo nontorsion joint cf      38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3935002004fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                                          
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        N                           
L3961002004include soft interface, straps, custom fabricated, includes fitting and                                                                                                                                                                                                                                              
L3961003004adjustment                                                                                                                                                                                                                                                                                                           
L3962001003Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, Sewho erbs palsey design abd38      A                                                                                                     C                          D1F P      01982010120010101        N                           
L3962002004prefabricated, 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        N                           
L3967002004thoracic component and support bar, without joints, may include soft interface,                                                                                                                                                                                                                                      
L3967003004straps, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                           
L3971001003Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more   Sewho cap design w/jnt(s) cf38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L3971002004nontorsion joints, elastic bands, turnbuckles, may include soft interface,                                                                                                                                                                                                                                           
L3971003004straps, custom fabricated, includes fitting and adjustment                                                                                                                                                                                                                                                           
L3973001003Shoulder elbow wrist hand orthosis, abduction positioning (airplane design),    Sewho airplane w/jnt(s) cf  38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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                                                                                                                                                                                                                                                                          
L3975001003Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, Sewhfo cap design w/o jnt cf38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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        N                           
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        N                           
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        N                           
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 Up ext fx orthos humeral nos38      A                                                                                                     C                          D1F P      01982010120150101        N                           
L3980002004adjustment                                                                                                                                                                                                                                                                                                           
L3981001003Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder    Ue fx orth shoul cap forearm38      A                                                                                                     C                          D1F P      02015010120150101        N                           
L3981002004cap design, with or without joints, forearm section, may include soft                                                                                                                                                                                                                                                
L3981003004interface, straps, includes fitting and adjustments                                                                                                                                                                                                                                                                  
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                                                                                                                                                                                                                                                                                                           
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 ortho pre ots 38      A                                                                                                     C                          D1F P      01989010120140101        N                           
L4350002004(e.g., pneumatic, gel), prefabricated, off-the-shelf                                                                                                                                                                                                                                                                 
L4360001003Walking boot, pneumatic and/or vacuum, with or without joints, with or without  Pneumat walking boot pre cst38      A                                                                                                     C                          D1F P      01989010120140101        N                           
L4360002004interface material, prefabricated item that has been trimmed, bent, molded,                                                                                                                                                                                                                                          
L4360003004assembled, or otherwise customized to fit a specific patient by an individual                                                                                                                                                                                                                                        
L4360004004with expertise                                                                                                                                                                                                                                                                                                       
L4361001003Walking boot, pneumatic and/or vacuum, with or without joints, with or without  Pneuma/vac walk boot pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L4361002004interface material, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                     
L4370001003Pneumatic full leg splint, prefabricated, off-the-shelf                         Pneum full leg splnt pre ots38      A                                                                                                     C                          D1F P      01989010120140101        N                           
L4386001003Walking boot, non-pneumatic, with or without joints, with or without interface  Non-pneum walk boot pre cst 38      A                                                                                                     C                          D1F P      02003010120140101        N                           
L4386002004material, prefabricated item that has been trimmed, bent, molded, assembled, or                                                                                                                                                                                                                                      
L4386003004otherwise customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                       
L4387001003Walking boot, non-pneumatic, with or without joints, with or without interface  Non-pneum walk boot pre ots 38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L4387002004material, prefabricated, off-the-shelf                                                                                                                                                                                                                                                                               
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 or dynamic ankle foot orthosis, including soft interface material,       Static or dynami afo pre cst38      A                                                                                                     C                          D1F P      01997010120140101        N                           
L4396002004adjustable for fit, for positioning, may be used for minimal ambulation,                                                                                                                                                                                                                                             
L4396003004prefabricated item that has been trimmed, bent, molded, assembled, or otherwise                                                                                                                                                                                                                                      
L4396004004customized to fit a specific patient by an individual with expertise                                                                                                                                                                                                                                                 
L4397001003Static or dynamic ankle foot orthosis, including soft interface material,       Static or dynami afo pre ots38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L4397002004adjustable for fit, for positioning, may be used for minimal ambulation,                                                                                                                                                                                                                                             
L4397003004prefabricated, off-the-shelf                                                                                                                                                                                                                                                                                         
L4398001003Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf    Foot drop splint pre ots    38      A                                                                                                     C                          D1F P      01997010120140101        N                           
L4631001003Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, Afo, walk boot type, cus fab38      A                                                                                                     C                          D1F P      02011010120110101        N                           
L4631002004anterior tibial shell, soft interface, custom arch support, plastic or other                                                                                                                                                                                                                                         
L4631003004material, includes straps and closures, custom fabricated                                                                                                                                                                                                                                                            
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                           
L5312001003Knee disarticulation (or through knee), molded socket, single axis knee, pylon, Knee disart, sach ft, endo  38      A                                                                                                     C                          D1F P      02012010120120101        N                           
L5312002004sach 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      01986010119860101        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      01986010119860101        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      01986010119860101        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      01986010119860101        N                           
L5642001003Addition to lower extremity, above knee, leather socket                         Above knee leather socket   38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5643001003Addition to lower extremity, hip disarticulation, flexible inner socket,        Hip flex inner socket ext fr38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L5643002004external frame                                                                                                                                                                                                                                                                                                       
L5644001003Addition to lower extremity, above knee, wood socket                            Above knee wood socket      38      A                                                                                                     C                          D1F P      01986010119860101        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      01988010119880101        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      01988010119880101        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      01988010119880101        N                           
L5652001003Addition to lower extremity, suction suspension, above knee or knee             Suction susp ak/knee disart 38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5652002004disarticulation socket                                                                                                                                                                                                                                                                                               
L5653001003Addition to lower extremity, knee disarticulation, expandable wall socket       Knee disart expand wall sock38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5654001003Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast,   Socket insert symes         38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5654002004plastazote or equal)                                                                                                                                                                                                                                                                                                 
L5655001003Addition to lower extremity, socket insert, below knee (kemblo, pelite,         Socket insert below knee    38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5655002004aliplast, plastazote or equal)                                                                                                                                                                                                                                                                                       
L5656001003Addition to lower extremity, socket insert, knee disarticulation (kemblo,       Socket insert knee articulat38      A                                                                                                     C                          D1F P      01986010119860101        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      01986010119860101        N                           
L5658002004aliplast, plastazote or equal)                                                                                                                                                                                                                                                                                       
L5661001003Addition to lower extremity, socket insert, multi-durometer symes               Multi-durometer symes       38      A                                                                                                     C                          D1F P      01988010119960101        N                           
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                 Bk molded distal cushion    38      A                                                                                                     C                          D1F P      01986010120140101        N                           
L5670001003Addition to lower extremity, below knee, molded supracondylar suspension ('pts' Bk molded supracondylar susp38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5670002004or 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      01986010119860101        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                                                                                                                                                                                                                                                                                
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      01986010119860101        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      01986010119860101        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      01986010119860101        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      01986010119860101        N                           
L5688001003Addition to lower extremity, below knee, waist belt, webbing                    Bk waist belt webbing       38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5690001003Addition to lower extremity, below knee, waist belt, padded and lined           Bk waist belt padded and lin38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5692001003Addition to lower extremity, above knee, pelvic control belt, light             Ak pelvic control belt light38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5694001003Addition to lower extremity, above knee, pelvic control belt, padded and lined  Ak pelvic control belt pad/l38      A                                                                                                     C                          D1F P      01986010119860101        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      01986010119860101        N                           
L5697001003Addition to lower extremity, above knee or knee disarticulation, pelvic band    Ak/knee disartic pelvic band38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5698001003Addition to lower extremity, above knee or knee disarticulation, silesian       Ak/knee disartic silesian ba38      A                                                                                                     C                          D1F P      01986010119860101        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        N                           
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      01986010119860101        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      01986010119860101        N                           
L5712002004phase control (safety knee)                                                                                                                                                                                                                                                                                          
L5714001003Addition, exoskeletal knee-shin system, single axis, variable friction swing    Knee-shin exo variable frict38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5714002004phase control                                                                                                                                                                                                                                                                                                        
L5716001003Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase    Knee-shin exo mech stance ph38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5716002004lock                                                                                                                                                                                                                                                                                                                 
L5718001003Addition, exoskeletal knee-shin system, polycentric, friction swing and stance  Knee-shin exo frct swg & sta38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5718002004phase control                                                                                                                                                                                                                                                                                                        
L5722001003Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction  Knee-shin pneum swg frct exo38      A                                                                                                     C                          D1F P      01986010119860101        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      01986010119860101        N                           
L5726001003Addition, exoskeletal knee-shin system, single axis, external joints fluid      Knee-shin ext jnts fld swg e38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5726002004swing phase control                                                                                                                                                                                                                                                                                                  
L5728001003Addition, exoskeletal knee-shin system, single axis, fluid swing and stance     Knee-shin fluid swg & stance38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L5728002004phase control                                                                                                                                                                                                                                                                                                        
L5780001003Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic  Knee-shin pneum/hydra pneum 38      A                                                                                                     C                          D1F P      01986010119860101        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                           
L5848001003Addition to endoskeletal knee-shin system, fluid stance extension, dampening    Knee-shin sys hydraul stance38      A                                                                                                     C                          D1F P      02003010120070101        N                           
L5848002004feature, with or without adjustability                                                                                                                                                                                                                                                                               
L5850001003Addition, endoskeletal system, above knee or hip disarticulation, knee          Endo ak/hip knee extens assi38      A                                                                                                     C                          D1F P      01988010119880101        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        N                           
L5858002004microprocessor control feature, stance phase only, includes electronic                                                                                                                                                                                                                                               
L5858003004sensor(s), any type                                                                                                                                                                                                                                                                                                  
L5859001003Addition to lower extremity prosthesis, endoskeletal knee-shin system, powered  Knee-shin pro flex/ext cont 38      A                                                                                                     C                          D1F P      02013010120130101        N                           
L5859002004and programmable flexion/extension assist control, includes any type motor(s)                                                                                                                                                                                                                                        
L5910001003Addition, endoskeletal system, below knee, alignable system                     Endo below knee alignable sy38      A                                                                                                     C                          D1F P      01988010119880101        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      01988010119880101        N                           
L5940002004carbon fiber or equal)                                                                                                                                                                                                                                                                                               
L5950001003Addition, endoskeletal system, above knee, ultra-light material (titanium,      Endo ak ultra-light material38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L5950002004carbon fiber or equal)                                                                                                                                                                                                                                                                                               
L5960001003Addition, endoskeletal system, hip disarticulation, ultra-light material        Endo hip ultra-light materia38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L5960002004(titanium, carbon fiber or equal)                                                                                                                                                                                                                                                                                    
L5961001003Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic    Endo poly hip, pneu/hyd/rot 38      A                                                                                                     C                          D1F P      02011010120110101        N                           
L5961002004control, rotation control, with or without flexion and/or extension control                                                                                                                                                                                                                                          
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                                                                                                                                                                                                                                                                                                 
L5969001003Addition, endoskeletal ankle-foot or ankle system, power assist, includes any   Ak/ft power asst incl motors38      A                                                                                                     C                          D1F P      02014010120140101        N                           
L5969002004type motor(s)                                                                                                                                                                                                                                                                                                        
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        N                           
L5971002004replacement only                                                                                                                                                                                                                                                                                                     
L5972001003All lower extremity prostheses, foot, flexible keel                             Flexible keel foot          38      A                                                                                                     C                          D1F P      01989010120130101        N                           
L5973001003Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion Ank-foot sys dors-plant flex38      A                                                                                                     C                          D1F P      02010010120100101        N                           
L5973002004and/or plantar flexion control, includes power source                                                                                                                                                                                                                                                                
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                           
L5990001003Addition to lower extremity prosthesis, user adjustable heel height             User adjustable heel height 38      A                                                                                                     C                          D1F P      02002010120020101        N                           
L5999001003Lower extremity prosthesis, not otherwise specified                             Lowr extremity prosthes nos 46      A                                                                                                     C                          D1F P      01982010119980101        N                           
L6000001003Partial hand, thumb remaining                                                   Part hand thumb rem         38      A                                                                                                     C                          D1F P      01982010120120101        N                           
L6010001003Partial hand, little and/or ring finger remaining                               Part hand little/ring       38      A                                                                                                     C                          D1F P      01982010120120101        N                           
L6020001003Partial hand, no finger remaining                                               Part hand no fingers        38      A                                                                                                     C                          D1F P      01982010120120101        N                           
L6025001003Transcarpal/metacarpal or partial hand disarticulation prosthesis, external     Part hand disart myoelectric38      A                                                                                                     C                          D1F P      0200301012015010120141231N                           
L6025002004power, self-suspended, inner socket with removable forearm section, electrodes                                                                                                                                                                                                                                       
L6025003004and cables, two batteries, charger, myoelectric control of terminal device                                                                                                                                                                                                                                           
L6026001003Transcarpal/metacarpal or partial hand disarticulation prosthesis, external     Part hand myo exclu term dev38      A                                                                                                     C                          D1F P      02015010120150101        N                           
L6026002004power, self-suspended, inner socket with removable forearm section, electrodes                                                                                                                                                                                                                                       
L6026003004and cables, two batteries, charger, myoelectric control of terminal device,                                                                                                                                                                                                                                          
L6026004004excludes terminal device(s)                                                                                                                                                                                                                                                                                          
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                           
L6611001003Addition to upper extremity prosthesis, external powered, additional switch,    Additional switch, ext power38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6611002004any type                                                                                                                                                                                                                                                                                                             
L6615001003Upper extremity addition, disconnect locking wrist unit                         Disconnect locking wrist uni38      A                                                                                                     C                          D1F P      01986010119860101        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 frictionFlexion/extension wrist unit38      A                                                                                                     C                          D1F P      01986010120040101        N                           
L6621001003Upper extremity prosthesis addition, flexion/extension wrist with or without    Flex/ext wrist w/wo friction38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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      01988010119880101        N                           
L6623002004release                                                                                                                                                                                                                                                                                                              
L6624001003Upper extremity addition, flexion/extension and rotation wrist unit             Flex/ext/rotation wrist unit38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6625001003Upper extremity addition, rotation wrist unit with cable lock                   Rotation wrst w/ cable lock 38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6628001003Upper extremity addition, quick disconnect hook adapter, otto bock or equal     Quick disconn hook adapter o38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L6629001003Upper extremity addition, quick disconnect lamination collar with coupling      Lamination collar w/ couplin38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L6629002004piece, otto bock or equal                                                                                                                                                                                                                                                                                            
L6630001003Upper extremity addition, stainless steel, any wrist                            Stainless steel any wrist   38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6632001003Upper extremity addition, latex suspension sleeve, each                         Latex suspension sleeve each38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L6635001003Upper extremity addition, lift assist for elbow                                 Lift assist for elbow       38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6637001003Upper extremity addition, nudge control elbow lock                              Nudge control elbow lock    38      A                                                                                                     C                          D1F P      01988010119880101        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      01988010119880101        N                           
L6642001003Upper extremity addition, excursion amplifier, lever type                       Excursion amplifier lever ty38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L6645001003Upper extremity addition, shoulder flexion-abduction joint, each                Shoulder flexion-abduction j38      A                                                                                                     C                          D1F P      01986010119860101        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      01986010119860101        N                           
L6655001003Upper extremity addition, standard control cable, extra                         Standard control cable extra38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6660001003Upper extremity addition, heavy duty control cable                              Heavy duty control cable    38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6665001003Upper extremity addition, teflon, or equal, cable lining                        Teflon or equal cable lining38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6670001003Upper extremity addition, hook to hand, cable adapter                           Hook to hand cable adapter  38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6672001003Upper extremity addition, harness, chest or shoulder, saddle type               Harness chest/shlder saddle 38      A                                                                                                     C                          D1F P      01986010119860101        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        N                           
L6677002004terminal device and elbow                                                                                                                                                                                                                                                                                            
L6680001003Upper extremity addition, test socket, wrist disarticulation or below elbow     Test sock wrist disart/bel e38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6682001003Upper extremity addition, test socket, elbow disarticulation or above elbow     Test sock elbw disart/above 38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6684001003Upper extremity addition, test socket, shoulder disarticulation or              Test socket shldr disart/tho38      A                                                                                                     C                          D1F P      01986010119860101        N                           
L6684002004interscapular thoracic                                                                                                                                                                                                                                                                                               
L6686001003Upper extremity addition, suction socket                                        Suction socket              38      A                                                                                                     C                          D1F P      01988010119880101        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      01988010119880101        N                           
L6690001003Upper extremity addition, frame type socket, interscapular-thoracic             Frame typ sock interscap-tho38      A                                                                                                     C                          D1F P      01988010119880101        N                           
L6691001003Upper extremity addition, removable insert, each                                Removable insert each       38      A                                                                                                     C                          D1F P      01988010119880101        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                                                                                                                                                                                                                                                                                    
L6703001003Terminal device, passive hand/mitt, any material, any size                      Term dev, passive hand mitt 38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6704001003Terminal device, sport/recreational/work attachment, any material, any size     Term dev, sport/rec/work att38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6706001003Terminal device, hook, mechanical, voluntary opening, any material, any size,   Term dev mech hook vol open 38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6706002004lined or unlined                                                                                                                                                                                                                                                                                                     
L6707001003Terminal device, hook, mechanical, voluntary closing, any material, any size,   Term dev mech hook vol close38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6707002004lined or unlined                                                                                                                                                                                                                                                                                                     
L6708001003Terminal device, hand, mechanical, voluntary opening, any material, any size    Term dev mech hand vol open 38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6709001003Terminal device, hand, mechanical, voluntary closing, any material, any size    Term dev mech hand vol close38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L6711001003Terminal device, hook, mechanical, voluntary opening, any material, any size,   Ped term dev, hook, vol open38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L6711002004lined or unlined, pediatric                                                                                                                                                                                                                                                                                          
L6712001003Terminal device, hook, mechanical, voluntary closing, any material, any size,   Ped term dev, hook, vol clos38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L6712002004lined or unlined, pediatric                                                                                                                                                                                                                                                                                          
L6713001003Terminal device, hand, mechanical, voluntary opening, any material, any size,   Ped term dev, hand, vol open38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L6713002004pediatric                                                                                                                                                                                                                                                                                                            
L6714001003Terminal device, hand, mechanical, voluntary closing, any material, any size,   Ped term dev, hand, vol clos38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L6714002004pediatric                                                                                                                                                                                                                                                                                                            
L6715001003Terminal device, multiple articulating digit, includes motor(s), initial issue  Term device, multi art digit38      A                                                                                                     C                          D1F P      02012010120120101        N                           
L6715002004or replacement                                                                                                                                                                                                                                                                                                       
L6721001003Terminal device, hook or hand, heavy duty, mechanical, voluntary opening, any   Hook/hand, hvy dty, vol open38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L6721002004material, any size, lined or unlined                                                                                                                                                                                                                                                                                 
L6722001003Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any   Hook/hand, hvy dty, vol clos38      A                                                                                                     C                          D1F P      02009010120090101        N                           
L6722002004material, any size, lined or unlined                                                                                                                                                                                                                                                                                 
L6805001003Addition to terminal device, modifier wrist unit                                Term dev modifier wrist unit38      A                  2133                                                                               D                          D1F P      01985010120070101        N                           
L6810001003Addition to terminal device, precision pinch device                             Term dev precision pinch dev38      A                  2133                                                                               D                          D1F P      01988010120070101        N                           
L6880001003Electric hand, switch or myoelectric controlled, independently articulating     Elec hand ind art digits    38      A                                                                                                     C                          D1F P      02012010120120101        N                           
L6880002004digits, any grasp pattern or combination of grasp patterns, includes motor(s)                                                                                                                                                                                                                                        
L6881001003Automatic grasp feature, addition to upper limb electric prosthetic terminal    Term dev auto grasp feature 38      A                                                                                                     C                          D1F P      02002010120070101        N                           
L6881002004device                                                                                                                                                                                                                                                                                                               
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        N                           
L6883002004for use with or without external power                                                                                                                                                                                                                                                                               
L6884001003Replacement socket, above elbow/elbow disarticulation, molded to patient model, Replc sockt above elbow disa38      A                                                                                                     C                          D1F P      02006010120070101        N                           
L6884002004for use with or without external power                                                                                                                                                                                                                                                                               
L6885001003Replacement socket, shoulder disarticulation/interscapular thoracic, molded to  Replc sockt shldr dis/interc38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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                                                                                                                                                                                                                                                                                           
L7007001003Electric hand, switch or myoelectric controlled, adult                          Adult electric hand         38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L7008001003Electric hand, switch or myoelectric, controlled, pediatric                     Pediatric electric hand     38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L7009001003Electric hook, switch or myoelectric controlled, adult                          Adult electric hook         38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L7040001003Prehensile actuator, switch controlled                                          Prehensile actuator         38      A                                                                                                     C                          D1F P      01988010120070101        N                           
L7045001003Electric hook, switch or myoelectric controlled, pediatric                      Pediatric electric hook     38      A                                                                                                     C                          D1F P      01988010120070101        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                           
L7259001003Electronic wrist rotator, any type                                              Electronic wrist rotator any38      A                                                                                                     C                          D1F P      02015010120150101        N                           
L7260001003Electronic wrist rotator, otto bock or equal                                    Electron wrist rotator otto 38      A                                                                            L7259                    C                          D1F P      0198801012015010120141231N                           
L7261001003Electronic wrist rotator, for utah arm                                          Electron wrist rotator utah 38      A                                                                            L7259                    C                          D1F P      0198801012015010120141231N                           
L7360001003Six volt battery, each                                                          Six volt bat otto bock/eq ea38      A                                                                                                     C                          D1F P      01988010120080101        N                           
L7362001003Battery charger, six volt, each                                                 Battery chrgr six volt otto 38      A                                                                                                     C                          D1F P      01988010120080101        N                           
L7364001003Twelve volt battery, each                                                       Twelve volt battery utah/equ38      A                                                                                                     C                          D1F P      01988010120080101        N                           
L7366001003Battery charger, twelve volt, each                                              Battery chrgr 12 volt utah/e38      A                                                                                                     C                          D1F P      01988010120080101        N                           
L7367001003Lithium ion battery, rechargeable, replacement                                  Replacemnt lithium ionbatter38      A                                                                                                     C                          D1F P      02003010120150101        N                           
L7368001003Lithium ion battery charger, replacement only                                   Lithium ion battery charger 38      A                                                                                                     C                          D1F P      02003010120120101        N                           
L7400001003Addition to upper extremity prosthesis, below elbow/wrist disarticulation,      Add ue prost be/wd, ultlite 38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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        N                           
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        N                           
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        N                           
L7403002004acrylic material                                                                                                                                                                                                                                                                                                     
L7404001003Addition to upper extremity prosthesis, above elbow disarticulation, acrylic    Add ue prost a/e acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L7404002004material                                                                                                                                                                                                                                                                                                             
L7405001003Addition to upper extremity prosthesis, shoulder disarticulation/interscapular  Add ue prost s/d acrylic    38      A                                                                                                     C                          D1F P      02006010120060101        N                           
L7405002004thoracic, acrylic material                                                                                                                                                                                                                                                                                           
L7499001003Upper extremity prosthesis, not otherwise specified                             Upper extremity prosthes nos46      A                                                                                                     C                          D1F P      01985010119980101        N                           
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   00      9                                          1862(1)(a)                                                 S                          D1F P      02006010120060101        N                           
L7700001003Gasket or seal, for use with prosthetic socket insert, any type, each           Pros soc insert gasket/seal 38      A                                                                                                     C                          D1F P      02018010120180101        N                           
L7900001003Male vacuum erection system                                                     Male vacuum erection system 00      9                                          1834a                                                      S                          D1F P      01997010120160101        N                           
L7902001003Tension ring, for vacuum erection device, any type, replacement only, each      Tension ring, vac erect dev 00      9                                          1834a                                                      S                          D1F P      02013010120160101        N                           
L8000001003Breast prosthesis, mastectomy bra, without integrated breast prosthesis form,   Mastectomy bra              38      A                  2130 A                                                                             D                          D1F P      01986010120130101        N                           
L8000002004any size, any type                                                                                                                                                                                                                                                                                                   
L8001001003Breast prosthesis, mastectomy bra, with integrated breast prosthesis form,      Breast prosthesis bra & form38      A                  2130A                                                                              D                          D1F P      02002010120130101        N                           
L8001002004unilateral, any size, any type                                                                                                                                                                                                                                                                                       
L8002001003Breast prosthesis, mastectomy bra, with integrated breast prosthesis form,      Brst prsth bra & bilat form 38      A                  2130A                                                                              D                          D1F P      02002010120130101        N                           
L8002002004bilateral, any size, any type                                                                                                                                                                                                                                                                                        
L8010001003Breast prosthesis, mastectomy sleeve                                            Mastectomy sleeve           00      9                  2130 A                                                                             D                          D1F P      01986010120050401        N                           
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, without integral adhesive                 Breast prosthes w/o adhesive38      A                  2130 A                                                                             D                          D1F P      01989010120100101        N                           
L8031001003Breast prosthesis, silicone or equal, with integral adhesive                    Breast prosthesis w adhesive38      A                  2130 A                                                                             D                          D1F P      02010010120100101        N                           
L8032001003Nipple prosthesis, reusable, any type, each                                     Reusable nipple prosthesis  38      A                                                                                                     C                          D1F P      02010010120100101        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                                                                                                                                                                                                                                                                              
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                           
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                                                                                                                                                                                                                                                                             
L8604001003Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant,        Dextranomer/hyaluronic acid 00      9                                                                                                     C                          D1F P      02009010120090101        N                           
L8604002004urinary tract, 1 ml, includes shipping and necessary supplies                                                                                                                                                                                                                                                        
L8605001003Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal   Inj bulking agent anal canal38      A                                                                                                     C                          D1F P      02013010120130101        N                           
L8605002004canal, 1 ml, includes 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                                                                                                                                                                                                                                                                             
L8607001003Injectable bulking agent for vocal cord medialization, 0.1 ml, includes         Inj vocal cord bulking agent38      A                  65.9                                                                               D                          D1F P      02016010120160101        N                           
L8607002004shipping and necessary supplies                                                                                                                                                                                                                                                                                      
L8608001003Miscellaneous external component, supply or accessory for use with the argus ii Arg ii ext com/sup/acc misc 46      A                                                                                                     C                          D1F P      02019010120190101        A                           
L8608002004retinal prosthesis system                                                                                                                                                                                                                                                                                            
L8609001003Artificial cornea                                                               Artificial cornea           38      A                                                                                                     C                          D1F P      02006010120060101        N                           
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, includes all internal and external components                  Cochlear device             38      A65-14             2130                                                                               D                          D1F P      01992010120070101        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 or auditory              Coch implant tran cable repl38      A65-14                                                                                                D                          D1F P      02005010120180101        N                           
L8618002004osseointegrated device, replacement                                                                                                                                                                                                                                                                                  
L8619001003Cochlear implant, external speech processor and controller, integrated system,  Coch imp ext proc/contr rplc38      A65-14                                                                                                D                          D1F P      01996010120100101        N                           
L8619002004replacement                                                                                                                                                                                                                                                                                                          
L8621001003Zinc air battery for use with cochlear implant device and auditory              Repl zinc air battery       38      A                                                                                                     C                          D1F P      02005010120160101        N                           
L8621002004osseointegrated sound processors, replacement, each                                                                                                                                                                                                                                                                  
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        N                           
L8623002004other than ear level, replacement, each                                                                                                                                                                                                                                                                              
L8624001003Lithium ion battery for use with cochlear implant or auditory osseointegrated   Lith ion batt cid, ear level38      A                                                                                                     C                          D1F P      02006010120180101        N                           
L8624002004device speech processor, ear level, replacement, each                                                                                                                                                                                                                                                                
L8625001003External recharging system for battery for use with cochlear implant or         Charger coch impl/aoi battry38      A65-14                                                                                                D                          D1F P      02018010120180101        N                           
L8625002004auditory osseointegrated device, replacement only, each                                                                                                                                                                                                                                                              
L8627001003Cochlear implant, external speech processor, component, replacement             Cid ext speech process repl 38      A65-14                                                                                                D                          D1F P      02010010120100101        N                           
L8628001003Cochlear implant, external controller component, replacement                    Cid ext controller repl     38      A65-14                                                                                                D                          D1F P      02010010120100101        N                           
L8629001003Transmitting coil and cable, integrated, for use with cochlear implant device,  Cid transmit coil and cable 38      A65-14                                                                                                D                          D1F P      02010010120100101        N                           
L8629002004replacement                                                                                                                                                                                                                                                                                                          
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                           
L8679001003Implantable neurostimulator, pulse generator, any type                          Imp neurosti pls gn any type38      A65-8                                                                                                 D                          D1F P      02014010120140101        N                           
L8680001003Implantable neurostimulator electrode, each                                     Implt neurostim elctr each  00      9                                                                                                     I                          D1F P      02006010120140401        N                           
L8681001003Patient programmer (external) for use with implantable programmable             Pt prgrm for implt neurostim38      A65-8                                                                                                 D                          D1F P      02006010120090101        N                           
L8681002004neurostimulator pulse generator, replacement only                                                                                                                                                                                                                                                                    
L8682001003Implantable neurostimulator radiofrequency receiver                             Implt neurostim radiofq rec 38      A65-8                                                                                                 D                          D1F P      02006010120060101        N                           
L8683001003Radiofrequency transmitter (external) for use with implantable neurostimulator  Radiofq trsmtr for implt neu38      A65-8                                                                                                 D                          D1F P      02006010120060101        N                           
L8683002004radiofrequency receiver                                                                                                                                                                                                                                                                                              
L8684001003Radiofrequency transmitter (external) for use with implantable sacral root      Radiof trsmtr implt scrl neu38      A65-8                                                                                                 D                          D1F P      02006010120060101        N                           
L8684002004neurostimulator receiver for bowel and bladder management, replacement                                                                                                                                                                                                                                               
L8685001003Implantable neurostimulator pulse generator, single array, rechargeable,        Implt nrostm pls gen sng rec00      9                                                                                                     I                          D1F P      02006010120140101        N                           
L8685002004includes extension                                                                                                                                                                                                                                                                                                   
L8686001003Implantable neurostimulator pulse generator, single array, non-rechargeable,    Implt nrostm pls gen sng non00      9                                                                                                     I                          D1F P      02006010120140101        N                           
L8686002004includes extension                                                                                                                                                                                                                                                                                                   
L8687001003Implantable neurostimulator pulse generator, dual array, rechargeable, includes Implt nrostm pls gen dua rec00      9                                                                                                     I                          D1F P      02006010120140101        N                           
L8687002004extension                                                                                                                                                                                                                                                                                                            
L8688001003Implantable neurostimulator pulse generator, dual array, non-rechargeable,      Implt nrostm pls gen dua non00      9                                                                                                     I                          D1F P      02006010120140101        N                           
L8688002004includes extension                                                                                                                                                                                                                                                                                                   
L8689001003External recharging system for battery (internal) for use with implantable      External recharg sys intern 38      A65-8                                                                                                 D                          D1F P      02006010120090101        N                           
L8689002004neurostimulator, replacement only                                                                                                                                                                                                                                                                                    
L8690001003Auditory osseointegrated device, includes all internal and external components  Aud osseo dev, int/ext comp 38      A                                                                                                     C                          D1F P      02007010120070101        N                           
L8691001003Auditory osseointegrated device, external sound processor, excludes             Aoi snd proc repl excl actua38      A                                                                                                     C                          D1F P      02007010120180101        N                           
L8691002004transducer/actuator, replacement only, each                                                                                                                                                                                                                                                                          
L8692001003Auditory osseointegrated device, external sound processor, used without         Non-osseointegrated snd proc00      9                                          1862(a)(7)                                                 S                          D1F P      02010010120100101        N                           
L8692002004osseointegration, body worn, includes headband or other means of external                                                                                                                                                                                                                                            
L8692003004attachment                                                                                                                                                                                                                                                                                                           
L8693001003Auditory osseointegrated device abutment, any length, replacement only          Aud osseo dev, abutment     38      A                                                                                                     C                          D1F P      02011010120110101        N                           
L8694001003Auditory osseointegrated device, transducer/actuator, replacement only, each    Aoi transducer/actuator repl38      A                                                                                                     C                          D1F P      02018010120180101        N                           
L8695001003External recharging system for battery (external) for use with implantable      External recharg sys extern 38      A65-8                                                                                                 D                          D1F P      02007010120090101        N                           
L8695002004neurostimulator, replacement only                                                                                                                                                                                                                                                                                    
L8696001003Antenna (external) for use with implantable diaphragmatic/phrenic nerve         Ext antenna phren nerve stim38      A                                                                                                     D                      0198D1F P      02015010120150101        N                           
L8696002004stimulation device, replacement, each                                                                                                                                                                                                                                                                                
L8698001003Miscellaneous component, supply or accessory for use with total artificial      Misc used with tot art heart46      A                                                                                                     D                      0178D1F P      02019010120190101        A                           
L8698002004heart system                                                                                                                                                                                                                                                                                                         
L8699001003Prosthetic implant, not otherwise specified                                     Prosthetic implant nos      46      A                                                                                                     C                          D1F P      01998010119980101        N                           
L8701001003Powered upper extremity range of motion assist device, elbow, wrist, hand with  Pow ue rom dev ewh uprt cust36      A                                                                                                     C                          D1E R      02019010120190101        A                           
L8701002004single or double upright(s), includes microprocessor, sensors, all components                                                                                                                                                                                                                                        
L8701003004and accessories, custom fabricated                                                                                                                                                                                                                                                                                   
L8702001003Powered upper extremity range of motion assist device, elbow, wrist, hand,      Pow ue rom dev ewhf uprt cus36      A                                                                                                     C                          D1E R      02019010120190101        A                           
L8702002004finger, single or double upright(s), includes microprocessor, sensors, all                                                                                                                                                                                                                                           
L8702003004components and accessories, custom fabricated                                                                                                                                                                                                                                                                        
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      0199201012015010120141231N                           
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                           
M1000001003Pain screened as moderate to severe                                             Pain scr as mod to sevr     00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1001001003Plan of care to address moderate to severe pain documented on or before the     Pln to adrs pain doc        00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1001002004date of the second visit with a clinician                                                                                                                                                                                                                                                                            
M1002001003Plan of care for moderate to severe pain not documented on or before the date   Pln to adrs pain not doc    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1002002004of the second visit with a clinician, reason not given                                                                                                                                                                                                                                                               
M1003001003Tb screening performed and results interpreted within twelve months prior to    Tb scr 12 mo pri fst bio dz 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1003002004initiation of first-time biologic disease modifying anti-rheumatic drug therapy                                                                                                                                                                                                                                      
M1003003004for ra                                                                                                                                                                                                                                                                                                               
M1004001003Documentation of medical reason for not screening for tb or interpreting        Doc med rsn no srn tb       00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1004002004results (i.e., patient positive for tb and documentation of past treatment;                                                                                                                                                                                                                                          
M1004003004patient who has recently completed a course of anti-tb therapy)                                                                                                                                                                                                                                                      
M1005001003Tb screening not performed or results not interpreted, reason not given         Tb scr no perf              00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1006001003Disease activity not assessed, reason not given                                 Dz not ases, no rsn         00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1007001003>=50% of total number of a patient's outpatient ra encounters assessed          >=50% total pt outpt ra enct00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1008001003<50% of total number of a patient's outpatient ra encounters assessed           <50% total pt outpt ra encts00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1009001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1010001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1011001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1012001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1013001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1014001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1015001003Patient treatment and final evaluation complete                                 Pt tx and final eval comp   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1016001003Female patients unable to bear children                                         Pt dx meop or sur steri     00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1017001003Patient admitted to palliative care services                                    Pt admt to palitve serv     00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1018001003Patients with an active diagnosis or history of cancer (except basal cell and   Pt dx hst cr pt sk lg cr scr00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1018002004squamous cell skin carcinoma), patients who are heavy tobacco smokers, lung                                                                                                                                                                                                                                          
M1018003004cancer screening patients                                                                                                                                                                                                                                                                                            
M1019001003Adolescent patients 12 to 17 years of age with major depression or dysthymia    Adl pt mj dep ds rs 12 phq<500      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1019002004who reached remission at twelve months as demonstrated by a twelve month (+/-60                                                                                                                                                                                                                                      
M1019003004days) phq-9 or phq-9m score of less than 5                                                                                                                                                                                                                                                                           
M1020001003Adolescent patients 12 to 17 years of age with major depression or dysthymia    Adl pt mj dep ds no rs 12 mo00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1020002004who did not reach remission at twelve months as demonstrated by a twelve month                                                                                                                                                                                                                                       
M1020003004(+/-60 days) phq-9 or phq-9m score of less than 5. either phq-9 or phq-9m score                                                                                                                                                                                                                                      
M1020004004was not assessed or is greater than or equal to 5                                                                                                                                                                                                                                                                    
M1021001003Patient had only urgent care visits during the performance period               Pt uc in pp                 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1022001003Patients who were in hospice at any time during the performance period          Pt hospice during perf pd   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1023001003Adolescent patients 12 to 17 years of age with major depression or dysthymia    Adl pt mj dep ds rs 6 phq<5 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1023002004who reached remission at six months as demonstrated by a six month (+/-60 days)                                                                                                                                                                                                                                      
M1023003004phq-9 or phq-9m score of less than five                                                                                                                                                                                                                                                                              
M1024001003Adolescent patients 12 to 17 years of age with major depression or dysthymia    Adl pt mj dep ds no rs 6 mo 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1024002004who did not reach remission at six months as demonstrated by a six month (+/-60                                                                                                                                                                                                                                      
M1024003004days) phq-9 or phq-9m score of less than five. either phq-9 or phq-9m score was                                                                                                                                                                                                                                      
M1024004004not assessed or is greater than or equal to five                                                                                                                                                                                                                                                                     
M1025001003Patients who were in hospice at any time during the performance period          Pt hospice during perf pd   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1026001003Patients who were in hospice at any time during the performance period          Pt hospice during perf pd   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1027001003Imaging of the head (ct or mri) was obtained                                    Img head (ct or mri) obtnd  00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1028001003Documentation of patients with primary headache diagnosis and imaging other     Doc of pt prm hda dx and otr00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1028002004than ct or mri obtained                                                                                                                                                                                                                                                                                              
M1029001003Imaging of the head (ct or mri) was not obtained, reason not given              Doc sysm rsn img hd         00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1030001003Patients with clinical indications for imaging of the head                      Pt clin ind img hd          00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1031001003Patients with no clinical indications for imaging of the head                   Pt clin ind img hd          00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1032001003Adults currently taking pharmacotherapy for oud                                 Adt tkng pharmthry for oud  00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1033001003Pharmacotherapy for oud initiated after june 30th of performance period         Pharmthry for oud afr 6.30  00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1034001003Adults who have at least 180 days of continuous pharmacotherapy with a          Adt 180 dys pharmthry oud   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1034002004medication prescribed for oud without a gap of more than seven days                                                                                                                                                                                                                                                  
M1035001003Adults who are deliberately phased out of medication assisted treatment (mat)   Adt pd out mat pr 180 dys tx00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1035002004prior to 180 days of continuous treatment                                                                                                                                                                                                                                                                            
M1036001003Adults who have not had at least 180 days of continuous pharmacotherapy with a  Adt no 180 dys pharmthry oud00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1036002004medication prescribed for oud without a gap of more than seven days                                                                                                                                                                                                                                                  
M1037001003Patients with a diagnosis of lumbar spine region cancer at the time of the      Pt dx lum sp reg cacr       00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1037002004procedure                                                                                                                                                                                                                                                                                                            
M1038001003Patients with a diagnosis of lumbar spine region fracture at the time of the    Pt dx lum sp reg fract      00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1038002004procedure                                                                                                                                                                                                                                                                                                            
M1039001003Patients with a diagnosis of lumbar spine region infection at the time of the   Pt dx lum sp reg inf        00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1039002004procedure                                                                                                                                                                                                                                                                                                            
M1040001003Patients with a diagnosis of lumbar idiopathic or congenital scoliosis          Pt dx lum idi or cong scol  00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1041001003Patient had cancer, fracture or infection related to the lumbar spine or        Pt cr ft inf lm or pt id sl 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1041002004patient had idiopathic or congenital scoliosis                                                                                                                                                                                                                                                                       
M1042001003Functional status measurement with score was obtained utilizing the oswestry    Ftl st mea sco ot odi 3 mo  00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1042002004disability index (odi version 2.1a) patient reported outcome tool within three                                                                                                                                                                                                                                       
M1042003004months preoperatively and at one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                               
M1043001003Functional status measurement with score was not obtained utilizing the         Ftl st mea sco no ot odi    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1043002004oswestry disability index (odi version 2.1a) patient reported outcome tool                                                                                                                                                                                                                                           
M1043003004within three months preoperatively and at one year (9 to 15 months)                                                                                                                                                                                                                                                  
M1043004004postoperatively                                                                                                                                                                                                                                                                                                      
M1044001003Functional status was measured by the oswestry disability index (odi version    Ftl st mea odi 3 mo         00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M10440020042.1a) patient reported outcome tool within three months preoperatively and at                                                                                                                                                                                                                                        
M1044003004one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                                                            
M1045001003Functional status measurement with score was obtained utilizing the oxford knee Fsm wth scr oks pre and post00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1045002004score (oks) patient reported outcome tool within three months preoperatively                                                                                                                                                                                                                                         
M1045003004and at one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                                                     
M1046001003Functional status measurement with score was not obtained utilizing the oxford  Fsm wth scr no oks pre and p00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1046002004knee score (oks) patient reported outcome tool within three months                                                                                                                                                                                                                                                   
M1046003004preoperatively and at one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                                      
M1047001003Functional status was measured by the oxford knee score (oks) patient reported  Fs msrd oks pre and post    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1047002004outcome tool within three months preoperatively and at one year (9 to 15                                                                                                                                                                                                                                             
M1047003004months) postoperatively                                                                                                                                                                                                                                                                                              
M1048001003Functional status measurement with score was obtained utilizing the oswestry    Fsm wth scr odi pre and post00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1048002004disability index (odi version 2.1a) patient reported outcome tool within three                                                                                                                                                                                                                                       
M1048003004months preoperatively and at three months (6 to 20 weeks) postoperatively                                                                                                                                                                                                                                            
M1049001003Functional status measurement with score was not obtained utilizing the         Fsm wth scr no odi pre and p00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1049002004oswestry disability index (odi version 2.1a) patient reported outcome tool                                                                                                                                                                                                                                           
M1049003004within three months preoperatively and at three months (6 to 20 weeks)                                                                                                                                                                                                                                               
M1049004004postoperatively                                                                                                                                                                                                                                                                                                      
M1050001003Functional status was measured by the oswestry disability index (odi version    Fs msrd odi pre and post    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M10500020042.1a) patient reported outcome tool within three months preoperatively and at                                                                                                                                                                                                                                        
M1050003004three months (6 to 20 weeks) postoperatively                                                                                                                                                                                                                                                                         
M1051001003Patient had cancer, fracture or infection related to the lumbar spine or        Pt w/cancer scoliosis       00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1051002004patient had idiopathic or congenital scoliosis                                                                                                                                                                                                                                                                       
M1052001003Leg pain was not measured by the visual analog scale (vas) within three months  Lg pn nt msr vas scl pre/pst00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1052002004preoperatively and at one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                                      
M1053001003Leg pain was measured by the visual analog scale (vas) within three months      Pre and post vas wthn 3 mos 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1053002004preoperatively and at one year (9 to 15 months) postoperatively                                                                                                                                                                                                                                                      
M1054001003Patient had only urgent care visits during the performance period               Pt uc in pp                 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1055001003Aspirin or another antiplatelet therapy used                                    Aspirin used                00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1056001003Prescribed anticoagulant medication during the performance period, history of   Presc antico med in pp      00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1056002004gi bleeding, history of intracranial bleeding, bleeding disorder and specific                                                                                                                                                                                                                                        
M1056003004provider documented reasons: allergy to aspirin or anti-platelets, use of                                                                                                                                                                                                                                            
M1056004004non-steroidal anti-inflammatory agents, drug-drug interaction, uncontrolled                                                                                                                                                                                                                                          
M1056005004hypertension > 180/110 mmhg or gastroesophageal reflux disease                                                                                                                                                                                                                                                       
M1057001003Aspirin or another antiplatelet therapy not used, reason not given              Aspirin not used, no rsn    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1058001003Patient was a permanent nursing home resident at any time during the            Pt prm nurs hm res in pp    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1058002004performance period                                                                                                                                                                                                                                                                                                   
M1059001003Patient was in hospice or receiving palliative care at any time during the      Pt no prm nurs hm res in pp 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1059002004performance period                                                                                                                                                                                                                                                                                                   
M1060001003Patient died prior to the end of the performance period                         Pt died in pp               00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1061001003Patient pregnancy                                                               Pt preg                     00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1062001003Patient immunocompromised                                                       Pt imcomprmd                00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1063001003Patients receiving high doses of immunosuppressive therapy                      Pt rec hg dos imsup thpy    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1064001003Shingrix vaccine documented as administered or previously received              Shing vac doc adm or pv rec 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1065001003Shingrix vaccine was not administered for reasons documented by clinician (e.g. Shing vac no adm clinc rsn  00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1065002004patient administered vaccine other than shingrix, patient allergy or other                                                                                                                                                                                                                                           
M1065003004medical reasons, patient declined or other patient reasons, vaccine not                                                                                                                                                                                                                                              
M1065004004available or other system reasons)                                                                                                                                                                                                                                                                                   
M1066001003Shingrix vaccine not documented as administered, reason not given               Shing vac no doc no rsn     00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1067001003Hospice services for patient provided any time during the measurement period    Hspc pt prv time meam per   00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1068001003Adults who are not ambulatory                                                   Pt not ambulatory           00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1069001003Patient screened for future fall risk                                           Pt scr ft fall rsk          00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1070001003Patient not screened for future fall risk, reason not given                     Pt not scrn fut fall no rsn 00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1071001003Patient had any additional spine procedures performed on the same date as the   Pt had add'l sp pcr perf    00      9                                                                                                     C                          Z2  1      02019010120190101        A                           
M1071002004lumbar discectomy/laminotomy                                                                                                                                                                                                                                                                                         
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                                                               Blood split unit            52      A                  2455A                                                                              D                          T1H 0      01987010120070101        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                                                                                                     CYY20080101                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                                                                                                     CYY20080101                Y2  9      02002010120020101        N                           
P9046001003Infusion, albumin (human), 25%, 20 ml                                           Albumin (human), 25%, 20 ml 52      A                                                                                                     CYY20080101                Y2  9      02002010120020101        N                           
P9047001003Infusion, albumin (human), 25%, 50 ml                                           Albumin (human), 25%, 50ml  52      A                                                                                                     CYY20080101                Y2  9      02002010120020101        N                           
P9048001003Infusion, plasma protein fraction (human), 5%, 250 ml                           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                           
P9070001003Plasma, pooled multiple donor, pathogen reduced, frozen, each unit              Pathogen reduced plasma pool52      A                                          1833T                                                      D                          T1H 9      02016010120160101        N                           
P9071001003Plasma (single donor), pathogen reduced, frozen, each unit                      Pathogen reduced plasma sing52      A                  2455B                   1833T                                                      D                          T1H 9      02016010120160101        N                           
P9072001003Platelets, pheresis, pathogen reduced or rapid bacterial tested, each unit      Plate path red/rapid bac tes52      A                                                                                                     I                          T1H 9      0201601012018010120171231N                           
P9073001003Platelets, pheresis, pathogen-reduced, each unit                                Platelets pheresis path redu52      A                  2455B                   1833T                                                      D                          T1H 9      02018010120190101        S                           
P9100001003Pathogen(s) test for platelets                                                  Pathogen test for platelets 57      A50-34                                                                                                D                          T1H 5      02018010120180101        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  5721    A                  5114.1D                                                                            D                          T1H 5      01999010120140101        N                           
P9612002004service                                                                                                                                                                                                                                                                                                              
P9615001003Catheterization for collection of specimen(s) (multiple patients)               Urine specimen collect mult 5721    A                  51141D                                                                             D                      0040T1H 5      01985010120140101        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 (e.g.,        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 technique(s)   Chemo by both infusion and o00      9                                                                                                     C                      0041O1D 1      01992010119960101        N                           
Q0085002004(e.g., subcutaneous, intramuscular, push), per visit                                                                                                                                                                                                                                                                 
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                           
Q0138001003Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd Ferumoxytol, non-esrd       51      A                                                                                                     CYY20100101                O1E 1P     02010010120100101        N                           
Q0138002004use)                                                                                                                                                                                                                                                                                                                 
Q0139001003Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd Ferumoxytol, esrd use       51      A                                                                                                     CYY20170101                O1E 1P     02010010120170101        N                           
Q0139002004on dialysis)                                                                                                                                                                                                                                                                                                         
Q0144001003Azithromycin dihydrate, oral, capsules/powder, 1 gram                           Azithromycin dihydrate, oral00      9                                                                                                     M                      0054O1E 1      01996070120020701        N                           
Q0161001003Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription             Chlorpromazine hcl 5mg oral 51      A                                                                                                     C                          O1D 1      02014010120140101        N                           
Q0161002004anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic                                                                                                                                                                                                                                      
Q0161003004at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen                                                                                                                                                                                                                                        
Q0162001003Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a     Ondansetron oral            51      A                                          4557                                                       D                          O1D 1P     02012010120120101        N                           
Q0162002004complete therapeutic substitute for an iv anti-emetic at the time of                                                                                                                                                                                                                                                 
Q0162003004chemotherapy treatment, not to exceed a 48 hour dosage regimen                                                                                                                                                                                                                                                       
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                                                                                                                                                                                                                                                    
Q0166001003Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic,   Granisetron hcl 1 mg oral   51      A                                          4557                                                       D                          O1D 1      01998040120090101        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                                                                                                                                                                                                                                                       
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                                                                                                                                                                                                                                        
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                                                                                                                                                                                                                                                       
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                                                                                                                                                                                                                                                       
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                                                                                                                                                                                                                                                       
Q0477001003Power module patient cable for use with electric or electric/pneumatic          Pwr module pt cable lvad rpl38      A                                                                                                     D                      0178D1F P      02018010120180101        N                           
Q0477002004ventricular assist device, replacement only                                                                                                                                                                                                                                                                          
Q0478001003Power adapter for use with electric or electric/pneumatic ventricular assist    Power adapter, combo vad    38      A                                                                                                     D                      0178D1F P      02011010120130101        N                           
Q0478002004device, vehicle type                                                                                                                                                                                                                                                                                                 
Q0479001003Power module for use with electric or electric/pneumatic ventricular assist     Power module combo vad, rep 38      A                                                                                                     D                      0178D1F P      02011010120130101        N                           
Q0479002004device, replacement only                                                                                                                                                                                                                                                                                             
Q0480001003Driver for use with pneumatic ventricular assist device, replacement only       Driver pneumatic vad, rep   38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0481001003Microprocessor control unit for use with electric ventricular assist device,    Microprcsr cu elec vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0481002004replacement only                                                                                                                                                                                                                                                                                                     
Q0482001003Microprocessor control unit for use with electric/pneumatic combination         Microprcsr cu combo vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0482002004ventricular assist device, replacement only                                                                                                                                                                                                                                                                          
Q0483001003Monitor/display module for use with electric ventricular assist device,         Monitor elec vad, rep       38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0483002004replacement only                                                                                                                                                                                                                                                                                                     
Q0484001003Monitor/display module for use with electric or electric/pneumatic ventricular  Monitor elec or comb vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0484002004assist device, replacement only                                                                                                                                                                                                                                                                                      
Q0485001003Monitor control cable for use with electric ventricular assist device,          Monitor cable elec vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0485002004replacement only                                                                                                                                                                                                                                                                                                     
Q0486001003Monitor control cable for use with electric/pneumatic ventricular assist        Mon cable elec/pneum vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0486002004device, replacement only                                                                                                                                                                                                                                                                                             
Q0487001003Leads (pneumatic/electrical) for use with any type electric/pneumatic           Leads any type vad, rep only38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
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                      0178D1F P      02005100120130101        N                           
Q0488002004only                                                                                                                                                                                                                                                                                                                 
Q0489001003Power pack base for use with electric/pneumatic ventricular assist device,      Pwr pck base combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0489002004replacement only                                                                                                                                                                                                                                                                                                     
Q0490001003Emergency power source for use with electric ventricular assist device,         Emr pwr source elec vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0490002004replacement only                                                                                                                                                                                                                                                                                                     
Q0491001003Emergency power source for use with electric/pneumatic ventricular assist       Emr pwr source combo vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0491002004device, replacement only                                                                                                                                                                                                                                                                                             
Q0492001003Emergency power supply cable for use with electric ventricular assist device,   Emr pwr cbl elec vad, rep   38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0492002004replacement only                                                                                                                                                                                                                                                                                                     
Q0493001003Emergency power supply cable for use with electric/pneumatic ventricular assist Emr pwr cbl combo vad, rep  38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0493002004device, replacement only                                                                                                                                                                                                                                                                                             
Q0494001003Emergency hand pump for use with electric or electric/pneumatic ventricular     Emr hd pmp elec/combo, rep  38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0494002004assist device, replacement only                                                                                                                                                                                                                                                                                      
Q0495001003Battery/power pack charger for use with electric or electric/pneumatic          Charger elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0495002004ventricular assist device, replacement only                                                                                                                                                                                                                                                                          
Q0496001003Battery, other than lithium-ion, for use with electric or electric/pneumatic    Battery elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0496002004ventricular assist device, replacement only                                                                                                                                                                                                                                                                          
Q0497001003Battery clips for use with electric or electric/pneumatic ventricular assist    Bat clps elec/comb vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0497002004device, replacement only                                                                                                                                                                                                                                                                                             
Q0498001003Holster for use with electric or electric/pneumatic ventricular assist device,  Holster elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0498002004replacement only                                                                                                                                                                                                                                                                                                     
Q0499001003Belt/vest/bag for use to carry external peripheral components of any type       Belt/vest elec/combo vad rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0499002004ventricular assist device, replacement only                                                                                                                                                                                                                                                                          
Q0500001003Filters for use with electric or electric/pneumatic ventricular assist device,  Filters elec/combo vad, rep 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0500002004replacement only                                                                                                                                                                                                                                                                                                     
Q0501001003Shower cover for use with electric or electric/pneumatic ventricular assist     Shwr cov elec/combo vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0501002004device, replacement only                                                                                                                                                                                                                                                                                             
Q0502001003Mobility cart for pneumatic ventricular assist device, replacement only         Mobility cart pneum vad, rep38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0503001003Battery for pneumatic ventricular assist device, replacement only, each         Battery pneum vad replacemnt38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0504001003Power adapter for pneumatic ventricular assist device, replacement only,        Pwr adpt pneum vad, rep veh 38      A                                                                                                     D                      0178D1F P      02005100120130101        N                           
Q0504002004vehicle type                                                                                                                                                                                                                                                                                                         
Q0506001003Battery, lithium-ion, for use with electric or electric/pneumatic ventricular   Lith-ion batt elec/pneum vad38      A                                                                                                     D                      0178D1F P      02010010120130101        N                           
Q0506002004assist device, replacement only                                                                                                                                                                                                                                                                                      
Q0507001003Miscellaneous supply or accessory for use with an external ventricular assist   Misc sup/acc ext vad        46      A                                                                                                     D                      0178D1F P      02013040120130401        N                           
Q0507002004device                                                                                                                                                                                                                                                                                                               
Q0508001003Miscellaneous supply or accessory for use with an implanted ventricular assist  Mis sup/acc imp vad         46      A                                                                                                     D                      0178D1F P      02013040120130401        N                           
Q0508002004device                                                                                                                                                                                                                                                                                                               
Q0509001003Miscellaneous supply or accessory for use with any implanted ventricular assist Mis sup/ac imp vad nopay med46      A                                                                                                     D                      0178D1F P      02013040120130401        N                           
Q0509002004device for which payment was not made under medicare part a                                                                                                                                                                                                                                                          
Q0510001003Pharmacy supply fee for initial immunosuppressive drug(s), first month          Dispens fee immunosupressive46      A                                                                                                     D                      0129O1E 9      02006010120060101        N                           
Q0510002004following transplant                                                                                                                                                                                                                                                                                                 
Q0511001003Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive Sup fee antiem,antica,immuno46      A                                                                                                     D                      0129O1E 9      02006010120060101        N                           
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                      0129O1E 9      02006010120090101        N                           
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 9      02006010120060101        N                           
Q0514001003Pharmacy dispensing fee for inhalation drug(s); per 90 days                     Disp fee inhal drugs/90 days46      A                                                                                                     D                      0129O1E 9      02006010120060101        N                           
Q0515001003Injection, sermorelin acetate, 1 microgram                                      Sermorelin acetate injection51      A                  2049                                                                               D                          O1E 1P     02006010120060101        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                           
Q2004001003Irrigation solution for treatment of bladder calculi, for example renacidin,    Bladder calculi irrig sol   51      A                  2049                    1861S2B                                                    D                          O1E 1P     02000070120070101        N                           
Q2004002004per 500 ml                                                                                                                                                                                                                                                                                                           
Q2009001003Injection, fosphenytoin, 50 mg phenytoin equivalent                             Fosphenytoin inj pe         51      A                  2049                    1861S2B                                                    D                          O1E 1P     02000070120190101        P                           
Q2017001003Injection, teniposide, 50 mg                                                    Teniposide, 50 mg           51      A                  2049                    1861S2B                                                    DYY20080101                O1D 1P     02000070120070101        N                           
Q2026001003Injection, radiesse, 0.1 ml                                                     Radiesse injection          51      A                                                                                                     DYY20190101            0166O1E 9      02010070120190101        P                           
Q2028001003Injection, sculptra, 0.5 mg                                                     Inj, sculptra, 0.5mg        51      A                                                                                                     DYY20190101            0166O1E 9      02014010120190101        P                           
Q2034001003Influenza virus vaccine, split virus, for intramuscular use (agriflu)           Agriflu vaccine             54      A                  2049.4                                                                             D                          O1G V      02012070120140101        N                           
Q2035001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Afluria vacc, 3 yrs & >, im 54      A                  2049.4                                                                             D                          O1G V      02011010120140101        N                           
Q2035002004of age and older, for intramuscular use (afluria)                                                                                                                                                                                                                                                                    
Q2036001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Flulaval vacc, 3 yrs & >, im54      A                  2049.4                                                                             D                          O1G V      02011010120140101        N                           
Q2036002004of age and older, for intramuscular use (flulaval)                                                                                                                                                                                                                                                                   
Q2037001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Fluvirin vacc, 3 yrs & >, im54      A                  2049.4                                                                             D                          O1G V      02011010120140101        N                           
Q2037002004of age and older, for intramuscular use (fluvirin)                                                                                                                                                                                                                                                                   
Q2038001003Influenza virus vaccine, split virus, when administered to individuals 3 years  Fluzone vacc, 3 yrs & >, im 54      A                  2049.4                                                                             D                          O1G V      02011010120140101        N                           
Q2038002004of age and older, for intramuscular use (fluzone)                                                                                                                                                                                                                                                                    
Q2039001003Influenza virus vaccine, not otherwise specified                                Influenza virus vaccine, nos54      A                  2049.4                                                                             D                          O1G V      02011010120170101        N                           
Q2040001003Tisagenlecleucel, up to 250 million car-positive viable t cells, including      Tisagenlecleucel car-pos t  51      A                                                                                                     CYY20180101                O1E 1      0201801012019010120181231D                           
Q2040002004leukapheresis and dose preparation procedures, per infusion                                                                                                                                                                                                                                                          
Q2041001003Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive    Axicabtagene ciloleucel car+51      A                                                                                                     C                          O1E 1      02018040120190101        C                           
Q2041002004viable t cells, including leukapheresis and dose preparation procedures, per                                                                                                                                                                                                                                         
Q2041003004therapeutic dose                                                                                                                                                                                                                                                                                                     
Q2042001003Tisagenlecleucel, up to 600 million car-positive viable t cells, including      Tisagenlecleucel car-pos t  51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q2042002004leukapheresis and dose preparation procedures, per therapeutic dose                                                                                                                                                                                                                                                  
Q2043001003Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with       Sipuleucel-t auto cd54+     53      A                                                                                                     DYY20110701            0175P1G 1      02011070120110701        N                           
Q2043002004pap-gm-csf, including leukapheresis and all other preparatory procedures, per                                                                                                                                                                                                                                        
Q2043003004infusion                                                                                                                                                                                                                                                                                                             
Q2049001003Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg        Imported lipodox inj        51      A                                                                                                     CYY20120701                O1D P      02012070120120701        N                           
Q2050001003Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg Doxorubicin inj 10mg        51      A                  2049.4                                                                             DYY20130701                O1D 19     02013070120130701        N                           
Q2052001003Services, supplies and accessories used in the home under the medicare          Ivig demo, services/supplies57      A                                                                                                     D                      0192O1E 9      02014040120140401        N                           
Q2052002004intravenous immune globulin (ivig) demonstration                                                                                                                                                                                                                                                                     
Q3001001003Radioelements for brachytherapy, any type, each                                 Brachytherapy radioelements 57      A                  15022                                                                              D                          P7A 1      02000070120050101        N                           
Q3014001003Telehealth originating site facility fee                                        Telehealth facility fee     53      A                                                                                                     C                          Y2  9      02001100120011001        N                           
Q3027001003Injection, interferon beta-1a, 1 mcg for intramuscular use                      Inj beta interferon im 1 mcg51      A                  2049                                                                               DYY20140101                O1E 1P     02014010120140101        N                           
Q3028001003Injection, interferon beta-1a, 1 mcg for subcutaneous use                       Inj beta interferon sq 1 mcg00      9                                                                                                     I                          O1E 1P     02014010120140101        N                           
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  55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4002001003Cast supplies, body cast adult, with or without head, fiberglass                Cast sup body cast fiberglas55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4003001003Cast supplies, shoulder cast, adult (11 years +), plaster                       Cast sup shoulder cast plstr55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4004001003Cast supplies, shoulder cast, adult (11 years +), fiberglass                    Cast sup shoulder cast fbrgl55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4005001003Cast supplies, long arm cast, adult (11 years +), plaster                       Cast sup long arm adult plst55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4006001003Cast supplies, long arm cast, adult (11 years +), fiberglass                    Cast sup long arm adult fbrg55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4007001003Cast supplies, long arm cast, pediatric (0-10 years), plaster                   Cast sup long arm ped plster55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4008001003Cast supplies, long arm cast, pediatric (0-10 years), fiberglass                Cast sup long arm ped fbrgls55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4009001003Cast supplies, short arm cast, adult (11 years +), plaster                      Cast sup sht arm adult plstr55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4010001003Cast supplies, short arm cast, adult (11 years +), fiberglass                   Cast sup sht arm adult fbrgl55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4011001003Cast supplies, short arm cast, pediatric (0-10 years), plaster                  Cast sup sht arm ped plaster55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4012001003Cast supplies, short arm cast, pediatric (0-10 years), fiberglass               Cast sup sht arm ped fbrglas55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4013001003Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years Cast sup gauntlet plaster   55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4013002004+), plaster                                                                                                                                                                                                                                                                                                          
Q4014001003Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years Cast sup gauntlet fiberglass55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4014002004+), fiberglass                                                                                                                                                                                                                                                                                                       
Q4015001003Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 Cast sup gauntlet ped plster55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4015002004years), plaster                                                                                                                                                                                                                                                                                                      
Q4016001003Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 Cast sup gauntlet ped fbrgls55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4016002004years), fiberglass                                                                                                                                                                                                                                                                                                   
Q4017001003Cast supplies, long arm splint, adult (11 years +), plaster                     Cast sup lng arm splint plst55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4018001003Cast supplies, long arm splint, adult (11 years +), fiberglass                  Cast sup lng arm splint fbrg55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4019001003Cast supplies, long arm splint, pediatric (0-10 years), plaster                 Cast sup lng arm splnt ped p55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4020001003Cast supplies, long arm splint, pediatric (0-10 years), fiberglass              Cast sup lng arm splnt ped f55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4021001003Cast supplies, short arm splint, adult (11 years +), plaster                    Cast sup sht arm splint plst55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4022001003Cast supplies, short arm splint, adult (11 years +), fiberglass                 Cast sup sht arm splint fbrg55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4023001003Cast supplies, short arm splint, pediatric (0-10 years), plaster                Cast sup sht arm splnt ped p55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4024001003Cast supplies, short arm splint, pediatric (0-10 years), fiberglass             Cast sup sht arm splnt ped f55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4025001003Cast supplies, hip spica (one or both legs), adult (11 years +), plaster        Cast sup hip spica plaster  55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4026001003Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass     Cast sup hip spica fiberglas55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4027001003Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster    Cast sup hip spica ped plstr55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4028001003Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass Cast sup hip spica ped fbrgl55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4029001003Cast supplies, long leg cast, adult (11 years +), plaster                       Cast sup long leg plaster   55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4030001003Cast supplies, long leg cast, adult (11 years +), fiberglass                    Cast sup long leg fiberglass55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4031001003Cast supplies, long leg cast, pediatric (0-10 years), plaster                   Cast sup lng leg ped plaster55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4032001003Cast supplies, long leg cast, pediatric (0-10 years), fiberglass                Cast sup lng leg ped fbrgls 55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4033001003Cast supplies, long leg cylinder cast, adult (11 years +), plaster              Cast sup lng leg cylinder pl55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4034001003Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass           Cast sup lng leg cylinder fb55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4035001003Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster          Cast sup lngleg cylndr ped p55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4036001003Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass       Cast sup lngleg cylndr ped f55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4037001003Cast supplies, short leg cast, adult (11 years +), plaster                      Cast sup shrt leg plaster   55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4038001003Cast supplies, short leg cast, adult (11 years +), fiberglass                   Cast sup shrt leg fiberglass55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4039001003Cast supplies, short leg cast, pediatric (0-10 years), plaster                  Cast sup shrt leg ped plster55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4040001003Cast supplies, short leg cast, pediatric (0-10 years), fiberglass               Cast sup shrt leg ped fbrgls55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4041001003Cast supplies, long leg splint, adult (11 years +), plaster                     Cast sup lng leg splnt plstr55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4042001003Cast supplies, long leg splint, adult (11 years +), fiberglass                  Cast sup lng leg splnt fbrgl55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4043001003Cast supplies, long leg splint, pediatric (0-10 years), plaster                 Cast sup lng leg splnt ped p55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4044001003Cast supplies, long leg splint, pediatric (0-10 years), fiberglass              Cast sup lng leg splnt ped f55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4045001003Cast supplies, short leg splint, adult (11 years +), plaster                    Cast sup sht leg splnt plstr55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4046001003Cast supplies, short leg splint, adult (11 years +), fiberglass                 Cast sup sht leg splnt fbrgl55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4047001003Cast supplies, short leg splint, pediatric (0-10 years), plaster                Cast sup sht leg splnt ped p55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4048001003Cast supplies, short leg splint, pediatric (0-10 years), fiberglass             Cast sup sht leg splnt ped f55      A                                                                                                     C                          D1A S      02001070120141001        N                           
Q4049001003Finger splint, static                                                           Finger splint, static       55      A                                                                                                     C                          D1A S      02001070120141001        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)                                                                                                                                                                                                                                                                                          
Q4074001003Iloprost, inhalation solution, fda-approved final product, non-compounded,      Iloprost non-comp unit dose 51      A                                                                                                     C                          D1G 1P     02010010120100101        N                           
Q4074002004administered through dme, unit dose form, up to 20 micrograms                                                                                                                                                                                                                                                        
Q4081001003Injection, epoetin alfa, 100 units (for esrd on dialysis)                       Epoetin alfa, 100 units esrd57      A                  4273.1                                                                             D                          O1E 1L     02007010120070101        N                           
Q4082001003Drug or biological, not otherwise classified, part b drug competitive           Drug/bio noc part b drug cap51      A                                                                                                     C                          D1E 1L     02007010120070101        N                           
Q4082002004acquisition program (cap)                                                                                                                                                                                                                                                                                            
Q4100001003Skin substitute, not otherwise specified                                        Skin substitute, nos        51      A                                                                                                     C                          O1E 1      02009010120090101        N                           
Q4101001003Apligraf, per square centimeter                                                 Apligraf                    51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4102001003Oasis wound matrix, per square centimeter                                       Oasis wound matrix          51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4103001003Oasis burn matrix, per square centimeter                                        Oasis burn matrix           51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4104001003Integra bilayer matrix wound dressing (bmwd), per square centimeter             Integra bmwd                51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4105001003Integra dermal regeneration template (drt) or integra omnigraft dermal          Integra drt or omnigraft    51      A                                                                                                     C                          O1E 1      02009010120170101        N                           
Q4105002004regeneration matrix, per square centimeter                                                                                                                                                                                                                                                                           
Q4106001003Dermagraft, per square centimeter                                               Dermagraft                  51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4107001003Graftjacket, per square centimeter                                              Graftjacket                 51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4108001003Integra matrix, per square centimeter                                           Integra matrix              51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4110001003Primatrix, per square centimeter                                                Primatrix                   51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4111001003Gammagraft, per square centimeter                                               Gammagraft                  51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4112001003Cymetra, injectable, 1 cc                                                       Cymetra injectable          51      A                                                                                                     C                          O1E 1      02009010120110101        N                           
Q4113001003Graftjacket xpress, injectable, 1 cc                                            Graftjacket xpress          51      A                                                                                                     C                          O1E 1      02009010120110101        N                           
Q4114001003Integra flowable wound matrix, injectable, 1 cc                                 Integra flowable wound matri51      A                                                                                                     C                          O1E 1      02009010120140101        N                           
Q4115001003Alloskin, per square centimeter                                                 Alloskin                    51      A                                                                                                     C                          O1E 1      02009070120140101        N                           
Q4116001003Alloderm, per square centimeter                                                 Alloderm                    51      A                                                                                                     C                          O1E 1      02009070120140101        N                           
Q4117001003Hyalomatrix, per square centimeter                                              Hyalomatrix                 51      A                                                                                                     C                          O1E 1      02011010120110101        N                           
Q4118001003Matristem micromatrix, 1 mg                                                     Matristem micromatrix       51      A                                                                                                     C                          O1E 1      02011010120140101        N                           
Q4119001003Matristem wound matrix, per square centimeter                                   Matristem wound matrix      51      A                                                                                                     C                          O1E 1      0201101012017010120161231N                           
Q4120001003Matristem burn matrix, per square centimeter                                    Matristem burn matrix       51      A                                                                                                     C                          O1E 1      0201101012017010120161231N                           
Q4121001003Theraskin, per square centimeter                                                Theraskin                   51      A                                                                                                     C                          O1E 1      02011010120180101        N                           
Q4122001003Dermacell, per square centimeter                                                Dermacell                   51      A                                                                                                     C                          O1E 1      02012010120160101        N                           
Q4123001003Alloskin rt, per square centimeter                                              Alloskin                    51      A                                                                                                     C                          O1E 1      02012010120120101        N                           
Q4124001003Oasis ultra tri-layer wound matrix, per square centimeter                       Oasis tri-layer wound matrix51      A                                                                                                     C                          O1E 1      02012010120140101        N                           
Q4125001003Arthroflex, per square centimeter                                               Arthroflex                  51      A                                                                                                     C                          O1E 1      02012010120120101        N                           
Q4126001003Memoderm, dermaspan, tranzgraft or integuply, per square centimeter             Memoderm/derma/tranz/integup51      A                                                                                                     C                          O1E 1      02012010120130101        N                           
Q4127001003Talymed, per square centimeter                                                  Talymed                     51      A                                                                                                     C                          O1E 1      02012010120160101        N                           
Q4128001003Flex hd, allopatch hd, or matrix hd, per square centimeter                      Flexhd/allopatchhd/matrixhd 51      A                                                                                                     C                          O1E 1      02012010120130101        N                           
Q4129001003Unite biomatrix, per square centimeter                                          Unite biomatrix             51      A                                                                                                     C                          O1E 1      0201201012017010120161231N                           
Q4130001003Strattice tm, per square centimeter                                             Strattice tm                51      A                                                                                                     C                          O1E 1      02012010120120101        N                           
Q4131001003Epifix or epicord, per square centimeter                                        Epifix or epicord           51      A                                                                                                     C                          O1E 1      0201301012019010120181231D                           
Q4132001003Grafix core and grafixpl core, per square centimeter                            Grafix core, grafixpl core  51      A                                                                                                     C                          O1E 1      02013010120180101        N                           
Q4133001003Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter      Grafix stravix prime pl sqcm51      A                                                                                                     C                          O1E 1      02013010120190101        C                           
Q4134001003Hmatrix, per square centimeter                                                  Hmatrix                     51      A                                                                                                     C                          O1E 1      02013010120130101        N                           
Q4135001003Mediskin, per square centimeter                                                 Mediskin                    51      A                                                                                                     C                          O1E 1      02013010120130101        N                           
Q4136001003Ez-derm, per square centimeter                                                  Ezderm                      51      A                                                                                                     C                          O1E 1      02013010120130101        N                           
Q4137001003Amnioexcel, amnioexcel plus or biodexcel, per square centimeter                 Amnioexcel biodexcel 1sq cm 51      A                                                                                                     C                          O1E 1      02014010120190101        C                           
Q4138001003Biodfence dryflex, per square centimeter                                        Biodfence dryflex, 1cm      51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4139001003Amniomatrix or biodmatrix, injectable, 1 cc                                     Amnio or biodmatrix, inj 1cc51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4140001003Biodfence, per square centimeter                                                Biodfence 1cm               51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4141001003Alloskin ac, per square centimeter                                              Alloskin ac, 1 cm           51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4142001003Xcm biologic tissue matrix, per square centimeter                               Xcm biologic tiss matrix 1cm51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4143001003Repriza, per square centimeter                                                  Repriza, 1cm                51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4145001003Epifix, injectable, 1 mg                                                        Epifix, inj, 1mg            51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4146001003Tensix, per square centimeter                                                   Tensix, 1cm                 51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4147001003Architect, architect px, or architect fx, extracellular matrix, per square      Architect ecm px fx 1 sq cm 51      A                                                                                                     C                          O1E 1      02014010120150101        N                           
Q4147002004centimeter                                                                                                                                                                                                                                                                                                           
Q4148001003Neox cord 1k, neox cord rt, or clarix cord 1k, per square centimeter            Neox neox rt or clarix cord 51      A                                                                                                     C                          O1E 1      02014010120180101        N                           
Q4149001003Excellagen, 0.1 cc                                                              Excellagen, 0.1 cc          51      A                                                                                                     C                          O1E 1      02014010120140101        N                           
Q4150001003Allowrap ds or dry, per square centimeter                                       Allowrap ds or dry 1 sq cm  51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4151001003Amnioband or guardian, per square centimeter                                    Amnioband, guardian 1 sq cm 51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4152001003Dermapure, per square centimeter                                                Dermapure 1 square cm       51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4153001003Dermavest and plurivest, per square centimeter                                  Dermavest, plurivest sq cm  51      A                                                                                                     C                          O1E 1      02015010120160101        N                           
Q4154001003Biovance, per square centimeter                                                 Biovance 1 square cm        51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4155001003Neoxflo or clarixflo, 1 mg                                                      Neoxflo or clarixflo 1 mg   51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4156001003Neox 100 or clarix 100, per square centimeter                                   Neox 100 or clarix 100      51      A                                                                                                     C                          O1E 1      02015010120180101        N                           
Q4157001003Revitalon, per square centimeter                                                Revitalon 1 square cm       51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4158001003Kerecis omega3, per square centimeter                                           Kerecis omega3, per sq cm   51      A                                                                                                     C                          O1E 1      02015010120180101        N                           
Q4159001003Affinity, per square centimeter                                                 Affinity1 square cm         51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4160001003Nushield, per square centimeter                                                 Nushield 1 square cm        51      A                                                                                                     C                          O1E 1      02015010120150101        N                           
Q4161001003Bio-connekt wound matrix, per square centimeter                                 Bio-connekt per square cm   51      A                                                                                                     C                          O1E 1      02016010120160101        N                           
Q4162001003Woundex flow, bioskin flow, 0.5 cc                                              Wndex flw, bioskn flw, 0.5cc51      A                                                                                                     C                          O1E 1      02016010120180101        N                           
Q4163001003Woundex, bioskin, per square centimeter                                         Woundex, bioskin, per sq cm 51      A                                                                                                     C                          O1E 1      02016010120180101        N                           
Q4164001003Helicoll, per square centimeter                                                 Helicoll, per square cm     51      A                                                                                                     C                          O1E 1      02016010120160101        N                           
Q4165001003Keramatrix, per square centimeter                                               Keramatrix, per square cm   51      A                                                                                                     C                          O1E 1      02016010120160101        N                           
Q4166001003Cytal, per square centimeter                                                    Cytal, per square centimeter51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4167001003Truskin, per square centimeter                                                  Truskin, per sq centimeter  51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4168001003Amnioband, 1 mg                                                                 Amnioband, 1 mg             51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4169001003Artacent wound, per square centimeter                                           Artacent wound, per sq cm   51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4170001003Cygnus, per square centimeter                                                   Cygnus, per sq cm           51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4171001003Interfyl, 1 mg                                                                  Interfyl, 1 mg              51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4172001003Puraply or puraply am, per square centimeter                                    Puraply or puraply am       51      A                                                                                                     C                          O1E 1      0201701012019010120181231D                           
Q4173001003Palingen or palingen xplus, per square centimeter                               Palingen or palingen xplus  51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4174001003Palingen or promatrx, 0.36 mg per 0.25 cc                                       Palingen or promatrx        51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4175001003Miroderm, per square centimeter                                                 Miroderm                    51      A                                                                                                     C                          O1E 1      02017010120170101        N                           
Q4176001003Neopatch, per square centimeter                                                 Neopatch, per sq centimeter 51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4177001003Floweramnioflo, 0.1 cc                                                          Floweramnioflo, 0.1 cc      51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4178001003Floweramniopatch, per square centimeter                                         Floweramniopatch, per sq cm 51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4179001003Flowerderm, per square centimeter                                               Flowerderm, per sq cm       51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4180001003Revita, per square centimeter                                                   Revita, per sq cm           51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4181001003Amnio wound, per square centimeter                                              Amnio wound, per square cm  51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4182001003Transcyte, per square centimeter                                                Transcyte, per sq centimeter51      A                                                                                                     C                          O1E 1      02018010120180101        N                           
Q4183001003Surgigraft, per square centimeter                                               Surgigraft, 1 sq cm         51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4184001003Cellesta, per square centimeter                                                 Cellesta, 1 sq cm           51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4185001003Cellesta flowable amnion (25 mg per cc); per 0.5 cc                             Cellesta flowab amnion 0.5cc51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4186001003Epifix, per square centimeter                                                   Epifix 1 sq cm              51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4187001003Epicord, per square centimeter                                                  Epicord 1 sq cm             51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4188001003Amnioarmor, per square centimeter                                               Amnioarmor 1 sq cm          51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4189001003Artacent ac, 1 mg                                                               Artacent ac, 1 mg           51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4190001003Artacent ac, per square centimeter                                              Artacent ac 1 sq cm         51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4191001003Restorigin, per square centimeter                                               Restorigin 1 sq cm          51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4192001003Restorigin, 1 cc                                                                Restorigin, 1 cc            51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4193001003Coll-e-derm, per square centimeter                                              Coll-e-derm 1 sq cm         51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4194001003Novachor, per square centimeter                                                 Novachor 1 sq cm            51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4195001003Puraply, per square centimeter                                                  Puraply 1 sq cm             51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
Q4196001003Puraply am, per square centimeter                                               Puraply am 1 sq cm          51      A                                                                                                     CYY20190101                O1E 1      02019010120190101        A                           
Q4197001003Puraply xt, per square centimeter                                               Puraply xt 1 sq cm          51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4198001003Genesis amniotic membrane, per square centimeter                                Genesis amnio membrane 1sqcm51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4200001003Skin te, per square centimeter                                                  Skin te 1 sq cm             51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4201001003Matrion, per square centimeter                                                  Matrion 1 sq cm             51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4202001003Keroxx (2.5g/cc), 1cc                                                           Keroxx (2.5g/cc), 1cc       51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4203001003Derma-gide, per square centimeter                                               Derma-gide, 1 sq cm         51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q4204001003Xwrap, per square centimeter                                                    Xwrap 1 sq cm               51      A                                                                                                     C                          O1E 1      02019010120190101        A                           
Q5001001003Hospice or home health care provided in patient's home/residence                Hospice or home hlth in home00      9                                                                                                     D                      0133Y2  1L     02007010120130701        N                           
Q5002001003Hospice or home health care provided in assisted living facility                Hospice/home hlth in asst lv00      9                                                                                                     D                      0133Y2  1L     02007010120130701        N                           
Q5003001003Hospice care provided in nursing long term care facility (ltc) or non-skilled   Hospice in lt/non-skilled nf00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N                           
Q5003002004nursing facility (nf)                                                                                                                                                                                                                                                                                                
Q5004001003Hospice care provided in skilled nursing facility (snf)                         Hospice in snf              00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N                           
Q5005001003Hospice care provided in inpatient hospital                                     Hospice, inpatient hospital 00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N                           
Q5006001003Hospice care provided in inpatient hospice facility                             Hospice in hospice facility 00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N                           
Q5007001003Hospice care provided in long term care facility                                Hospice in ltch             00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N                           
Q5008001003Hospice care provided in inpatient psychiatric facility                         Hospice in inpatient psych  00      9                                                                                                     D                      0133Y2  1L     02007010120070101        N                           
Q5009001003Hospice or home health care provided in place not otherwise specified (nos)     Hospice/home hlth, place nos00      9                                                                                                     D                      0133Y2  1L     02007010120130701        N                           
Q5010001003Hospice home care provided in a hospice facility                                Hospice home care in hospice00      9                                                                                                     D                      0133Y2  1L     02010100120101001        N                           
Q5101001003Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram                   Injection, zarxio           51      A                                                                                                     DYY20150701            0187O1E 1P     02015070120180401        C                           
Q5102001003Injection, infliximab, biosimilar, 10 mg                                        Inj., infliximab biosimilar 51      A                  2049                                                                               D                          O1E 1P     0201607012018040120180331D                           
Q5103001003Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg                      Injection, inflectra        51      A                                                                                                     DYY20180401            0187O1E 1P     02018040120180401        A                           
Q5104001003Injection, infliximab-abda, biosimilar, (renflexis), 10 mg                      Injection, renflexis        51      A                                                                                                     DYY20180401            0187O1E 1P     02018040120180401        A                           
Q5105001003Injection, epoetin alfa, biosimilar, (retacrit) (for esrd on dialysis), 100     Inj retacrit esrd on dialysi57      A                  4273.1                                                                             DYY20180701                O1E 1L     02018070120180701        A                           
Q5105002004units                                                                                                                                                                                                                                                                                                                
Q5106001003Injection, epoetin alfa, biosimilar, (retacrit) (for non-esrd use), 1000 units  Inj retacrit non-esrd use   51      A                  2049                                                                               DYY20180701                O1E 9      02018070120180701        A                           
Q5107001003Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg                         Inj mvasi 10 mg             51      A                                                                                                     D                      0187O1E 1P     02019010120190101        A                           
Q5108001003Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg                   Injection, fulphila         53      A                                                                                                     CYY20181001                O1E 1P     02018100120181001        A                           
Q5109001003Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg                          Injection, ixifi, 10 mg     51      A                                                                                                     D                      0187O1E 1P     02019010120190101        A                           
Q5110001003Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram                 Nivestym                    51      A                  2049                                                                               DYY20181001                O1E 1P     02018100120181001        A                           
Q9950001003Injection, sulfur hexafluoride lipid microspheres, per ml                       Inj sulf hexa lipid microsph57      A                                                                                                     CYY20181001                I1F 4      02016010120181001        P                           
Q9951001003Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per mlLocm >= 400 mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005040120050401        N                           
Q9953001003Injection, iron-based magnetic resonance contrast agent, per ml                 Inj fe-based mr contrast,1ml57      A                  15022                                                                              D                          I1F 4      02005040120050401        N                           
Q9954001003Oral magnetic resonance contrast agent, per 100 ml                              Oral mr contrast, 100 ml    57      A                  15022                                                                              D                          I1F 4      02005040120050401        N                           
Q9955001003Injection, perflexane lipid microspheres, per ml                                Inj perflexane lip micros,ml57      A                                                                                                     C                          I1F 4      02005040120050401        N                           
Q9956001003Injection, octafluoropropane microspheres, per ml                               Inj octafluoropropane mic,ml57      A                                                                                                     C                          I1F 4      02005040120050401        N                           
Q9957001003Injection, perflutren lipid microspheres, per ml                                Inj perflutren lip micros,ml57      A                                                                                                     C                          I1F 4      02005040120050401        N                           
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        N                           
Q9959001003High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml      Hocm 150-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N                           
Q9960001003High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml      Hocm 200-249mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N                           
Q9961001003High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml      Hocm 250-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N                           
Q9962001003High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml      Hocm 300-349mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N                           
Q9963001003High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml      Hocm 350-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02005070120050701        N                           
Q9964001003High osmolar contrast material, 400 or greater mg/ml iodine concentration, per  Hocm>= 400mg/ml iodine, 1ml 51      A                  15022                                                                              D                          I1E 4      02005070120050701        N                           
Q9964002004ml                                                                                                                                                                                                                                                                                                                   
Q9965001003Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml       Locm 100-199mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02008010120080101        N                           
Q9966001003Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml       Locm 200-299mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02008010120080101        N                           
Q9967001003Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml       Locm 300-399mg/ml iodine,1ml51      A                  15022                                                                              D                          I1E 4      02008010120080101        N                           
Q9968001003Injection, non-radioactive, non-contrast, visualization adjunct (e.g.,          Visualization adjunct       51      A                                                                                                     CYY20150101                I1E 4      02010010120140101        N                           
Q9968002004methylene blue, isosulfan blue), 1 mg                                                                                                                                                                                                                                                                                
Q9969001003Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per  Non-heu tc-99m add-on/dose  53      A                                                                                                     D                      0179Y1  9      02013010120130101        N                           
Q9969002004study dose                                                                                                                                                                                                                                                                                                           
Q9970001003Injection, ferric carboxymaltose, 1mg                                           Inj ferric carboxymaltos 1mg51      A                                                                                                     C                          O1E 1P     0201407012015010120141231N                           
Q9972001003Injection, epoetin beta, 1 microgram, (for esrd on dialysis)                    Epoetin beta esrd use       57      A                                                                            J0887                    D                      0195O1E 1L     0201407012015010120141231N                           
Q9973001003Injection, epoetin beta, 1 microgram, (non-esrd use)                            Epoetin beta non esrd       57      A                                                                            J0888                    D                      0195O1E 9      0201407012015010120141231N                           
Q9974001003Injection, morphine sulfate, preservative-free for epidural or intrathecal use, Morphine epidural/intratheca51      A60-14             2049                                                      J2274                    D                          O1E 1P     0201407012015010120141231N                           
Q997400200410 mg                                                                                                                                                                                                                                                                                                                
Q9975001003Injection, factor viii fc fusion protein (recombinant), per iu                  Factor viii fc fusion recomb51      A                                                                            J7205                    D                      0127O1E 1P     0201504012016010120151231N                           
Q9976001003Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron                Inj ferric pyrophosphate cit51      A                                                                            J1443                    C                          O1E 1L     0201507012016010120151231N                           
Q9977001003Compounded drug, not otherwise classified                                       Compounded drug noc         51      A                                                                                                     D                      0205O1E 1      0201507012016010120151231N                           
Q9978001003Netupitant 300 mg and palonosetron 0.5 mg                                       Netupitant palonosetron oral51      A                                                                            J8655                    D                      0204O1E 1      0201507012016010120151231N                           
Q9979001003Injection, alemtuzumab, 1 mg                                                    Injection, alemtuzumab      51      A                                                                            J0202                    D                      0127O1E 1P     0201510012016010120151231N                           
Q9980001003Hyaluronan or derivative, genvisc 850, for intra-articular injection, 1 mg      Genvisc, inj, 1mg           51      A                                                                                                     C                          O1E 1      0201601012017010120161231N                           
Q9981001003Rolapitant, oral, 1 mg                                                          Rolapitant, oral, 1mg       51      A                                                                            J8670                    D                      0187O1E 1      0201607012017010120161231N                           
Q9982001003Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries               Flutemetamol f18 diagnostic 00      9                                                                                                     D                      0189I1E 4      02016070120190101        P                           
Q9983001003Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries              Florbetaben f18 diagnostic  00      9                                                                                                     D                      0189I1E 4      02016070120190101        P                           
Q9984001003Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg   Kyleena, 19.5 mg            00      9                                          1862(a)(1)                        J7296                    S                          P6C 9      0201707012018010120171231N                           
Q9985001003Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg         Inj hydroxyprogst capoat nos51      A                                                                            J1729                    C                          O1E 1P     0201707012018010120171231N                           
Q9986001003Injection, hydroxyprogesterone caproate, (makena), 10 mg                        Makena, 10 mg               51      A                                                                            J1726                    C                          O1E 1P     0201707012018010120171231N                           
Q9987001003Pathogen(s) test for platelets                                                  Pathogen test for platelets 57      A50-34                                                                       P9100                    D                          T1H 5      0201707012018010120171231N                           
Q9988001003Platelets, pheresis, pathogen-reduced, each unit                                Platelets, pathogen reduced 52      A                  2455B                   1833T                             P9073                    D                          T1H 9      0201707012018010120171231N                           
Q9989001003Ustekinumab, for intravenous injection, 1 mg                                    Ustekinumab, iv inject,1 mg 51      A                                                                            J3358                    C                          O1E 1P     0201707012018010120171231N                           
Q9991001003Injection, buprenorphine extended-release (sublocade), less than or equal to    Buprenorph xr 100 mg or less51      A                                                                                                     CYY20180701                O1E 1      02018070120180701        A                           
Q9991002004100 mg                                                                                                                                                                                                                                                                                                               
Q9992001003Injection, buprenorphine extended-release (sublocade), greater than 100 mg      Buprenorphine xr over 100 mg51      A                                                                                                     CYY20180701                O1E 1      02018070120180701        A                           
Q9993001003Injection, triamcinolone acetonide, preservative-free, extended-release,        Inj., triamcinolone ext rel 51      A                                                                            J3304                    D                      0127O1E 1P     0201807012019010120181231D                           
Q9993002004microsphere formulation, 1 mg                                                                                                                                                                                                                                                                                        
Q9994001003In-line cartridge containing digestive enzyme(s) for enteral feeding, each      Enzyme cartridge enteral nut00      9                                                                            B4105                    D                      0217O1C E      0201807012019010120181231D                           
Q9995001003Injection, emicizumab-kxwh, 0.5 mg                                              Inj., emicizumab-kxwh 0.5 mg51      A                                                                            J7170                    C                          O1E 1      0201807012019010120181231D                           
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                      0061I1F 5      01984010119980101        N                           
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                           
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                           
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                           
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                           
S0088001003Imatinib, 100 mg                                                                Imatinib 100 mg             00      9                                                                                                     I                      0088Z2  9      02002010120081001        N                           
S0090001003Sildenafil citrate, 25 mg                                                       Sildenafil citrate, 25 mg   00      9                                                                                                     I                      0088Z2  1P     02000010120000101        N                           
S0091001003Granisetron hydrochloride, 1 mg (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                           
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                           
S0117001003Tretinoin, topical, 5 grams                                                     Tretinoin topical 5 g       00      9                                                                                                     I                          Z2  9      02004070120040701        N                           
S0119001003Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute,  Ondansetron 4 mg            00      9                                                                                                     I                          Z2  9      02012010120120101        N                           
S0119002004use hcpcs q code)                                                                                                                                                                                                                                                                                                    
S0122001003Injection, menotropins, 75 iu                                                   Inj menotropins 75 iu       00      9                                                                                                     I                          Z2  1P     02002040120020401        N                           
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                           
S0132001003Injection, ganirelix acetate, 250 mcg                                           Inj ganirelix acetat 250 mcg00      9                                                                                                     I                          Z2  1P     02002040120020401        N                           
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                           
S0142001003Colistimethate sodium, inhalation solution administered through dme,            Colistimethate inh sol mg   00      9                                                                                                     I                          Z2  9      02005040120050401        N                           
S0142002004concentrated form, per mg                                                                                                                                                                                                                                                                                            
S0144001003Injection, propofol, 10 mg                                                      Inj, propofol, 10 mg        00      9                                                                            J2704                    I                          Z2  9      0201407012015010120141231N                           
S0145001003Injection, pegylated interferon alfa-2a, 180 mcg per ml                         Peg interferon alfa-2a/180  00      9                                                                                                     I                          Z2  9      02005070120050701        N                           
S0148001003Injection, pegylated interferon alfa-2b, 10 mcg                                 Peg interferon alfa-2b/10   00      9                                                                                                     I                          Z2  9      02010100120101001        N                           
S0155001003Sterile dilutant for epoprostenol, 50 ml                                        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                           
S0160001003Dextroamphetamine sulfate, 5 mg                                                 Dextroamphetamine           00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0164001003Injection, pantoprazole sodium, 40 mg                                           Injection pantroprazole     00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S0166001003Injection, olanzapine, 2.5 mg                                                   Inj olanzapine 2.5mg        00      9                                                                                                     I                          Z2  9      02004100120041001        N                           
S0169001003Calcitrol, 0.25 microgram                                                       Calcitrol                   00      9                                                                                                     I                          Z2  9      02010100120101001        N                           
S0170001003Anastrozole, oral, 1 mg                                                         Anastrozole 1 mg            00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N                           
S0171001003Injection, bumetanide, 0.5 mg                                                   Bumetanide 0.5 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0172001003Chlorambucil, oral, 2 mg                                                        Chlorambucil 2 mg           00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0174001003Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare   Dolasetron 50 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0174002004statute, use q0180)                                                                                                                                                                                                                                                                                                  
S0175001003Flutamide, oral, 125 mg                                                         Flutamide 125 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0176001003Hydroxyurea, oral, 500 mg                                                       Hydroxyurea 500 mg          00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0177001003Levamisole hydrochloride, oral, 50 mg                                           Levamisole 50 mg            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0178001003Lomustine, oral, 10 mg                                                          Lomustine 10 mg             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0179001003Megestrol acetate, oral, 20 mg                                                  Megestrol 20 mg             00      9                                                                                                     I                      0088Z2  1P     02002010120020101        N                           
S0182001003Procarbazine hydrochloride, oral, 50 mg                                         Procarbazine, oral          00      9                                                                                                     I                      0088Z2  9      02002010120140101        N                           
S0183001003Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the       Prochlorperazine 5 mg       00      9                                                                                                     I                      0088Z2  9      02002010120150101        N                           
S0183002004medicare statute, use q0164)                                                                                                                                                                                                                                                                                         
S0187001003Tamoxifen citrate, oral, 10 mg                                                  Tamoxifen 10 mg             00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S0189001003Testosterone pellet, 75 mg                                                      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                           
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      0200301012016010120151231N                           
S0195002004five years to nine years of age who have not previously received the vaccine                                                                                                                                                                                                                                         
S0197001003Prenatal vitamins, 30-day supply                                                Prenatal vitamins 30 day    00      9                                                                                                     I                          Z2  9      02005040120050401        N                           
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                           
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        N                           
S0270001003Physician management of patient home care, standard monthly case rate (per 30   Home std case rate 30 days  00      9                                                                                                     I                          Z2  9      02007040120070401        N                           
S0270002004days)                                                                                                                                                                                                                                                                                                                
S0271001003Physician management of patient home care, hospice monthly case rate (per 30    Home hospice case 30 days   00      9                                                                                                     I                          Z2  9      02007040120070401        N                           
S0271002004days)                                                                                                                                                                                                                                                                                                                
S0272001003Physician management of patient home care, episodic care monthly case rate (per Home episodic case 30 days  00      9                                                                                                     I                          Z2  9      02007040120070401        N                           
S027200200430 days)                                                                                                                                                                                                                                                                                                             
S0273001003Physician visit at member's home, outside of a capitation arrangement           Md home visit outside cap   00      9                                                                                                     I                          Z2  9      02007040120070401        N                           
S0274001003Nurse practitioner visit at member's home, outside of a capitation arrangement  Nurse practr visit outs cap 00      9                                                                                                     I                          Z2  9      02007040120070401        N                           
S0280001003Medical home program, comprehensive care coordination and planning, initial planMedical home, initial plan  00      9                                                                                                     I                          Z2  9      02010010120100101        N                           
S0281001003Medical home program, comprehensive care coordination and planning, maintenance Medical home, maintenance   00      9                                                                                                     I                          Z2  9      02010010120100101        N                           
S0281002004of plan                                                                                                                                                                                                                                                                                                              
S0285001003Colonoscopy consultation performed prior to a screening colonoscopy procedure   Cnslt before screen colonosc00      9                                                                                                     I                      0088Z2  9      02016070120160701        N                           
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)                                                                                                                                                                                                                                                                                   
S0311001003Comprehensive management and care coordination for advanced illness, per        Comp mgmt care coord adv ill00      9                                                                                                     I                          Z2  9      02016070120160701        N                           
S0311002004calendar month                                                                                                                                                                                                                                                                                                       
S0315001003Disease management program; initial assessment and initiation of the program    Disease management program  00      9                                                                                                     I                          Z2  9      02002100120021001        N                           
S0316001003Disease management program, follow-up/reassessment                              Follow-up/reassessment      00      9                                                                                                     I                          Z2  9      02002100120061001        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                                                                                                                                                                                                                                                            
S0353001003Treatment planning and care coordination management for cancer, initial         Cancer treatmentplan initial00      9                                                                                                     I                          Z2  9      02012040120120401        N                           
S0353002004treatment                                                                                                                                                                                                                                                                                                            
S0354001003Treatment planning and care coordination management for cancer, established     Cancer treatment plan change00      9                                                                                                     I                          Z2  9      02012040120120401        N                           
S0354002004patient with a change of regimen                                                                                                                                                                                                                                                                                     
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                                                                                                                                                                                                                                          
S0390003004visit                                                                                                                                                                                                                                                                                                                
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        N                           
S0596001003Phakic intraocular lens for correction of refractive error                      Phakic iol refractive error 00      9                                                                                                     I                          Z2  9      02012040120120401        N                           
S0601001003Screening proctoscopy                                                           Screening proctoscopy       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        N                           
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)                                                                                                                                                                                                                                                              
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                           
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                                                                                                                                                                                                                                                                          
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)                                                                                                                                                                                                                                                                                                  
S1034001003Artificial pancreas device system (e.g., low glucose suspend (lgs) feature)     Art pancreas system         00      9                                                                                                     I                          Z2  9      02014070120140701        N                           
S1034002004including continuous glucose monitor, blood glucose device, insulin pump and                                                                                                                                                                                                                                         
S1034003004computer algorithm that communicates with all of the devices                                                                                                                                                                                                                                                         
S1035001003Sensor; invasive (e.g., subcutaneous), disposable, for use with artificial      Art pancreas inv disp sensor00      9                                                                                                     I                          Z2  9      02014070120140701        N                           
S1035002004pancreas device system                                                                                                                                                                                                                                                                                               
S1036001003Transmitter; external, for use with artificial pancreas device system           Art pancreas ext transmitter00      9                                                                                                     I                          Z2  9      02014070120140701        N                           
S1037001003Receiver (monitor); external, for use with artificial pancreas device system    Art pancreas ext receiver   00      9                                                                                                     I                          Z2  9      02014070120140701        N                           
S1040001003Cranial remolding orthosis, pediatric, rigid, with soft interface material,     Cranial remolding orthosis  00      9                                                                                                     I                          Z2  P      02002100120070101        N                           
S1040002004custom fabricated, includes fitting and adjustment(s)                                                                                                                                                                                                                                                                
S1090001003Mometasone furoate sinus implant, 370 micrograms                                Mometasone sinus implant    00      9                                                                                                     I                          Z2  9      02012070120120701        N                           
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                           
S2066001003Breast reconstruction with gluteal artery perforator (gap) flap, including      Breast gap flap reconst     00      9                                                                                                     I                          Z2  2      02007070120070701        N                           
S2066002004harvesting of the flap, microvascular transfer, closure of donor site and                                                                                                                                                                                                                                            
S2066003004shaping the flap into a breast, unilateral                                                                                                                                                                                                                                                                           
S2067001003Breast reconstruction of a single breast with "stacked" deep inferior           Breast "stacked" diep/gap   00      9                                                                                                     I                          Z2  2      02007070120070701        N                           
S2067002004epigastric perforator (diep) flap(s) and/or gluteal artery perforator (gap)                                                                                                                                                                                                                                          
S2067003004flap(s), including harvesting of the flap(s), microvascular transfer, closure                                                                                                                                                                                                                                        
S2067004004of donor site(s) and shaping the flap into a breast, unilateral                                                                                                                                                                                                                                                      
S2068001003Breast reconstruction with deep inferior epigastric perforator (diep) flap or   Breast diep or siea flap    00      9                                                                                                     I                          Z2  9      02006010120070701        N                           
S2068002004superficial inferior epigastric artery (siea) flap, including harvesting of the                                                                                                                                                                                                                                      
S2068003004flap, microvascular transfer, closure of donor site and shaping the flap into a                                                                                                                                                                                                                                      
S2068004004breast, 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)                                                                                                                                                                                                                                                    
S2079001003Laparoscopic esophagomyotomy (heller type)                                      Lap esophagomyotomy         00      9                                                                                                     I                          Z2  9      02006010120060101        N                           
S2080001003Laser-assisted uvulopalatoplasty (laup)                                         Laup                        00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2083001003Adjustment of gastric band diameter via subcutaneous port by injection or       Adjustment gastric band     00      9                                                                                                     I                          Z2  9      02004040120040401        N                           
S2083002004aspiration of saline                                                                                                                                                                                                                                                                                                 
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       Adoptive immunotherapy      00      9                                                                                                     I                          Z2  9      02002040120020401        N                           
S2107002004(e.g., tumor-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                           
S2115001003Osteotomy, periacetabular, with internal fixation                               Periacetabular osteotomy    00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S2117001003Arthroereisis, subtalar                                                         Arthroereisis, subtalar     00      9                                                                                                     I                          Z2  9      02005100120051001        N                           
S2118001003Metal-on-metal total hip resurfacing, including acetabular and femoral          Total hip resurfacing       00      9                                                                                                     I                          Z2  9      02008100120081001        N                           
S2118002004components                                                                                                                                                                                                                                                                                                           
S2120001003Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal    Low density lipoprotein(ldl)00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S2120002004ldl precipitation                                                                                                                                                                                                                                                                                                    
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                                                                                                                                                                                                                                                                                                           
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                                                                                                                                                                                                                                                                    
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                           
S2260001003Induced abortion, 17 to 24 weeks                                                Induced abortion 17-24 weeks00      9                                                                                                     I                      0088Z2  9      02002010120070101        N                           
S2265001003Induced abortion, 25 to 28 weeks                                                Induced abortion 25-28 wks  00      9                                                                                                     I                          Z2  9      02002100120070101        N                           
S2266001003Induced abortion, 29 to 31 weeks                                                Induced abortion 29-31 wks  00      9                                                                                                     I                          Z2  9      02002100120070101        N                           
S2267001003Induced abortion, 32 weeks or greater                                           Induced abortion 32 or more 00      9                                                                                                     I                          Z2  9      02002100120070101        N                           
S2300001003Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy          Arthroscopy, shoulder, surgi00      9                                                                                                     I                      0088Z2  9      02000010120000101        N                           
S2325001003Hip core decompression                                                          Hip core decompression      00      9                                                                                                     I                          Z2  9      02006100120061001        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      0200201012016010120151231N                           
S2360002004injection; cervical                                                                                                                                                                                                                                                                                                  
S2361001003Each additional cervical vertebral body (list separately in addition to code    Vertebroplast cerv addl     00      9                                                                                                     I                      0088Z2  9      0200201012016010120151231N                           
S2361002004for primary procedure)                                                                                                                                                                                                                                                                                               
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        N                           
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        N                           
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                                                                                                     D                      0088Z2  9      02001010120010701        N                           
S3620002004laboratory tests specified by the state for inclusion in this panel (e.g.,                                                                                                                                                                                                                                           
S3620003004galactose; hemoglobin, electrophoresis;  hydroxyprogesterone, 17-d;                                                                                                                                                                                                                                                  
S3620004004phenylalanine (pku); and thyroxine, total)                                                                                                                                                                                                                                                                           
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                           
S3708001003Gastrointestinal fat absorption study                                           Gastrointestinal fat absorpt00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S3721001003Prostate cancer antigen 3 (pca3) testing                                        Pca3 testing                00      9                                                                                                     I                          Z2  9      0201204012016010120151231N                           
S3722001003Dose optimization by area under the curve (auc) analysis, for infusional        Dose optimization auc - 5fu 00      9                                                                                                     I                          Z2  9      02012010120120101        N                           
S37220020045-fluorouracil                                                                                                                                                                                                                                                                                                       
S3800001003Genetic testing for amyotrophic lateral sclerosis (als)                         Genetic testing als         00      9                                                                                                     I                          Z2  9      02007070120070701        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                           
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                           
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                           
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      02006010120160701        N                           
S3854002004treatment                                                                                                                                                                                                                                                                                                            
S3855001003Genetic testing for detection of mutations in the presenilin - 1 gene           Gene test presenilin-1 gene 00      9                                                                                                     I                          Z2  9      0200701012015010120141231N                           
S3861001003Genetic testing, sodium channel, voltage-gated, type v, alpha subunit (scn5a)   Genetic test brugada        00      9                                                                                                     I                          Z2  9      02008100120081001        N                           
S3861002004and variants for suspected brugada syndrome                                                                                                                                                                                                                                                                          
S3865001003Comprehensive gene sequence analysis for hypertrophic cardiomyopathy            Comp genet test hyp cardiomy00      9                                                                                                     I                          Z2  9      02009040120090401        N                           
S3866001003Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy   Spec gene test hyp cardiomy 00      9                                                                                                     I                          Z2  9      02009040120090401        N                           
S3866002004(hcm) in an individual with a known hcm mutation in the family                                                                                                                                                                                                                                                       
S3870001003Comparative genomic hybridization (cgh) microarray testing for developmental    Cgh test developmental delay00      9                                                                                                     I                          Z2  9      02009040120140101        N                           
S3870002004delay, autism spectrum disorder and/or intellectual disability                                                                                                                                                                                                                                                       
S3890001003Dna analysis, fecal, for colorectal cancer screening                            Fecal dna analysis          00      9                                                                                                     I                          Z2  9      0200404012016010120151231N                           
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                           
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      0200101012016010120151231N                           
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 venous catheter, nursing services   Hip midline cath insert kit 00      9                                                                                                     I                      0088Z2  9      02002010120060701        N                           
S5523002004only (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                           
S8030001003Scleral application of tantalum ring(s) for localization of lesions for proton  Tantalum ring application   00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8030002004beam therapy                                                                                                                                                                                                                                                                                                         
S8032001003Low-dose computed tomography for lung cancer screening                          Low dose ct lung screening  00      9                                                                            G0297                    I                      0088Z2  9      0201410012016100120160930N                           
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                           
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)                                                                                                                                                                                                                                                                                         
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                           
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                           
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                           
S8130001003Interferential current stimulator, 2 channel                                    Interferential stim 2 chan  00      9                                                                                                     I                          Z2  9      02012010120120101        N                           
S8131001003Interferential current stimulator, 4 channel                                    Interferential stim 4 chan  00      9                                                                                                     I                          Z2  9      02012010120120101        N                           
S8185001003Flutter device                                                                  Flutter device              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8186001003Swivel adapter                                                                  Swivel adaptor              00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8189001003Tracheostomy supply, not otherwise classified                                   Trach supply noc            00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S8210001003Mucus trap                                                                      Mucus trap                  00      9                                                                                                     I                      0088Z2  9      02001010120010101        N                           
S8262001003Mandibular orthopedic repositioning device, each                                Mandib ortho repos device   00      9                                                                                                     I                          Z2  9      0200204012015070120150630N                           
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        N                           
S8301001003Infection control supplies, not otherwise specified                             Infect control supplies nos 00      9                                                                                                     I                          Z2  9      02004070120040701        N                           
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                           
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                           
S8490001003Insulin syringes (100 syringes, any size)                                       100 insulin syringes        00      9                                                                                                     I                      0088Z2  S      02002010120020101        N                           
S8930001003Electrical stimulation of auricular acupuncture points; each 15 minutes of      Auricular electrostimulation00      9                                                                                                     I                          Z2  9      02012040120120401        N                           
S8930002004personal one-on-one contact with the patient                                                                                                                                                                                                                                                                         
S8940001003Equestrian/hippotherapy, per session                                            Hippotherapy per session    00      9                                                                                                     I                          Z2  9      02005040120050401        N                           
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      0200101012016010120151231N                           
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                                                                                                                                                                                                                                                                                                             
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                           
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        Home phototherapy visit     00      9                                                                                                     I                      0088Z2  9      02002010120020101        N                           
S9098002004rental, nursing services, blood draw, supplies, and other services, per diem                                                                                                                                                                                                                                         
S9110001003Telemonitoring of patient in their home, including all necessary equipment;     Telemonitoring/home per mnth00      9                                                                                                     I                          Z2  9      02013010120130101        N                           
S9110002004computer system, connections, and software; maintenance; patient education and                                                                                                                                                                                                                                       
S9110003004support; 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                           
S9152001003Speech therapy, re-evaluation                                                   Speech therapy, re-eval     00      9                                                                                                     I                          Z2  9      02007070120070701        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)                                                                                                                                                                                                                                                                      
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 or intermittent anti-emetic infusion therapy; Hit cont antiemetic diem    00      9                                                                                                     I                      0088Z2  9      02002010120070401        N                           
S9351002004administrative services, professional pharmacy services, care coordination, and                                                                                                                                                                                                                                      
S9351003004all necessary supplies and equipment (drugs and visits coded separately), per                                                                                                                                                                                                                                        
S9351004004diem                                                                                                                                                                                                                                                                                                                 
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                           
S9433001003Medical food nutritionally complete, administered orally, providing 100% of     Medical food oral 100% nutr 00      9                                                                                                     I                          Z2  9      02009010120090101        N                           
S9433002004nutritional intake                                                                                                                                                                                                                                                                                                   
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                                                                                                                                                                                                                                                                                   
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                                                                                                                                                                                                                                         
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                                                                                                                                                                                                                                                                       
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 a journal-listed christian science practitioner for the purpose of  Christian sci pract visit   00      9                                                                                                     I                          Z2  9      02002070120120101        N                           
S9900002004healing, per diem                                                                                                                                                                                                                                                                                                    
S9901001003Services by a journal-listed christian science nurse, per hour                  Christian sci nurse visit   00      9                                                                                                     I                          Z2  9      02015010120150101        N                           
S9960001003Ambulance service, conventional air service, nonemergency transport, one way    Air ambulanc nonemerg fixed 00      9                                                                                                     I                          O1A D      02014010120140101        N                           
S9960002004(fixed wing)                                                                                                                                                                                                                                                                                                         
S9961001003Ambulance service, conventional air service, nonemergency transport, one way    Air ambulan nonemerg rotary 00      9                                                                                                     I                          O1A D      02014010120140101        N                           
S9961002004(rotary wing)                                                                                                                                                                                                                                                                                                        
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 service(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                                                                                                                                                                                                                                                                                                         
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)                                                                                                                                                                                                                                                                                   
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                           
T1040001003Medicaid certified community behavioral health clinic services, per diem        Comm bh clinic svc per diem 00      9                                                                                                     I                          Z2  9      02017010120170101        N                           
T1041001003Medicaid certified community behavioral health clinic services, per month       Comm bh clinic svc per month00      9                                                                                                     I                          Z2  9      02017010120170101        N                           
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                                                                                                                                                                                                                                                                                  
T1503001003Administration of medication, other than oral and/or injectable, by a health    Med admin, not oral/inject  00      9                                                                                                     I                          Z2  9      02007040120070401        N                           
T1503002004care agency/professional, per visit                                                                                                                                                                                                                                                                                  
T1505001003Electronic medication compliance management device, includes all components and Elec med comp dev, noc      00      9                                                                                                     I                          Z2  9      02011010120110101        N                           
T1505002004accessories, not otherwise classified                                                                                                                                                                                                                                                                                
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                           
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                           
T4543001003Adult sized disposable incontinence product, protective brief/diaper, above     Adult disp brief/diap abv xl00      960-9                                                                                                 M                          D1A 9      02007010120140101        N                           
T4543002004extra large, each                                                                                                                                                                                                                                                                                                    
T4544001003Adult sized disposable incontinence product, protective underwear/pull-on,      Adlt disp und/pull on abv xl00      960-9                                                                                                 M                          D1A 9      02014010120140101        N                           
T4544002004above extra large, each                                                                                                                                                                                                                                                                                              
T4545001003Incontinence product, disposable, penile wrap, each                             Incon disposable penile wrap00      960.9                                                                                                 M                          D1A 9      02019010120190101        A                           
T5001001003Positioning seat for persons with special orthopedic needs                      Position seat spec orth need00      9                                                                                                     I                          Z2  P      02004010120070101        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      01985010119850101        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      01985010119850101        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                           
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      01985010119850101        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      01985010119850101        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                           
V2218001003Aniseikonic, per lens, bifocal                                                  Lens aniseikonic bifocal    38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
V2219001003Bifocal seg width over 28 mm                                                    Lens bifocal seg width over 38      A                                                                                                     C                          D1F Q      01985010119850101        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      01985010119850101        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      01985010119850101        N                           
V2315001003Lenticular, (myodisc), per lens, trifocal                                       Lens lenticular trifocal    38      A                                                                                                     C                          D1F Q      01985010120031001        N                           
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      01985010119850101        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, hydrophilic, bifocal, per lens                                    Cntct lens hydrophil bifocl 38      A45-7  65-1                                                                                           D                          D1F Q      01985010119850101        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 lens56      A                  2130                                                                               D                          D1F Q      01985010120141001        N                           
V2631001003Iris supported intraocular lens                                                 Iris support intraoclr lens 56      A                  2130                                                                               D                          D1F Q      01985010120141001        N                           
V2632001003Posterior chamber intraocular lens                                              Post chmbr intraocular lens 56      A                  2130                                                                               D                          D1F Q      01985010120141001        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                           
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                                                                                                     C                          Z2  Q      02004010120070101        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                                                                                                     CYY20080101                D1F Q      01990010120031001        N                           
V2786001003Specialty occupational multifocal lens, per lens                                Occupational multifocal lens38      A                  2130.B                                                                             D                          D1F Q      02004010120040101        N                           
V2787001003Astigmatism correcting function of intraocular lens                             Astigmatism-correct function00      9                                          1862(a)(7)                                                 S                          Z2  Q      02008010120080101        N                           
V2788001003Presbyopia correcting function of intraocular lens                              Presbyopia-correct function 00      9                                          1862(a)(7)                                                 S                          Z2  Q      02006010120060101        N                           
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 item or service, miscellaneous                                           Misc vision item or service 46      A                                                                                                     C                          D1F Q      01985010120150101        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      0198201012019010120181231D                           
V5171001003Hearing aid, contralateral routing device, monaural, in the ear (ite)           Hearing aid monaural ite    00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5172001003Hearing aid, contralateral routing device, monaural, in the canal (itc)         Hearing aid monaural itc    00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5180001003Hearing aid, cros, behind the ear                                               Behind ear cros hearing aid 00      9                                          1862A7                                                     S                          O1F K      0198201012019010120181231D                           
V5181001003Hearing aid, contralateral routing device, monaural, behind the ear (bte)       Hearing aid monaural bte    00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5190001003Hearing aid, contralateral routing, monaural, glasses                           Hearing aid monaural glasses00      9                                          1862A7                                                     S                          O1F K      01982010120190101        C                           
V5200001003Dispensing fee, contralateral, monaural                                         Disp fee contralateral monau00      9                                          1862A7                                                     S                          O1F K      01982010120190101        C                           
V5210001003Hearing aid, bicros, in the ear                                                 In ear bicros hearing aid   00      9                                          1862A7                                                     S                          O1F K      0198201012019010120181231D                           
V5211001003Hearing aid, contralateral routing system, binaural, ite/ite                    Hearing aid binaural ite/ite00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5212001003Hearing aid, contralateral routing system, binaural, ite/itc                    Hearing aid binaural ite/itc00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5213001003Hearing aid, contralateral routing system, binaural, ite/bte                    Hearing aid binaural ite/bte00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5214001003Hearing aid, contralateral routing system, binaural, itc/itc                    Hearing aid binaural itc/itc00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5215001003Hearing aid, contralateral routing system, binaural, itc/bte                    Hearing aid binaural itc/bte00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5220001003Hearing aid, bicros, behind the ear                                             Behind ear bicros hearing ai00      9                                          1862A7                                                     S                          O1F K      0198201012019010120181231D                           
V5221001003Hearing aid, contralateral routing system, binaural, bte/bte                    Hearing aid binaural bte/bte00      9                                          1862A7                                                     S                          O1F K      02019010120190101        A                           
V5230001003Hearing aid, contralateral routing system, binaural, glasses                    Hearing aid binaural glasses00      9                                          1862A7                                                     S                          O1F K      01982010120190101        C                           
V5240001003Dispensing fee, contralateral routing system, binaural                          Disp fee contralateral binau00      9                                          1862A7                                                     S                          O1F K      01982010120190101        C                           
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 or assistive listening device/supplies/accessories, not otherwise   Hearing aid sup/access/dev  00      9                                          1862A7                                                     S                          O1F K      02002010120130101        N                           
V5267002004specified                                                                                                                                                                                                                                                                                                            
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                           
V5281001003Assistive listening device, personal fm/dm system, monaural, (1 receiver,       Ald fm/dm system, monaural  00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5281002004transmitter, microphone), any type                                                                                                                                                                                                                                                                                   
V5282001003Assistive listening device, personal fm/dm system, binaural, (2 receivers,      Ald fm/dm system binaural   00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5282002004transmitter, microphone), any type                                                                                                                                                                                                                                                                                   
V5283001003Assistive listening device, personal fm/dm neck, loop induction receiver        Ald neck, loop ind receiver 00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5284001003Assistive listening device, personal fm/dm, ear level receiver                  Ald fm/dm ear level receiver00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5285001003Assistive listening device, personal fm/dm, direct audio input receiver         Ald fm/dm aud input receiver00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5286001003Assistive listening device, personal blue tooth fm/dm receiver                  Ald blu tooth fm/dm receiver00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5287001003Assistive listening device, personal fm/dm receiver, not otherwise specified    Ald fm/dm receiver, nos     00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5288001003Assistive listening device, personal fm/dm transmitter assistive listening      Ald fm/dm transmitter ald   00      9                                          1862a7                                                     S                          O1F K      02013010120130101        N                           
V5288002004device                                                                                                                                                                                                                                                                                                               
V5289001003Assistive listening device, personal fm/dm adapter/boot coupling device for     Ald fm/dm adapt/boot couplin00      9                                          1862a7                                                     S                      0000O1F K      02013010120130101        N                           
V5289002004receiver, any type                                                                                                                                                                                                                                                                                                   
V5290001003Assistive listening device, transmitter microphone, any type                    Ald transmitter microphone  00      9                                          1862a7                                                     S                          O1F K      02013010120130101        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                           
