PRIOR AUTHORIZATION METRICS FOR MEDICAL ITEMS AND SERVICES (EXCLUDING DRUGS)
New York Medicaid - List of Goods and Services that required Prior Authorizations during 2025.
- Items List is also available in Portable Document Format (PDF)
| Procedure Code | Description |
|---|---|
| 11950 | INJECTION OF FILLING MATERIAL UNDER SKIN, 1.0 CC OR LESS |
| 11951 | INJECTION OF FILLING MATERIAL UNDER SKIN, 1.1-5.0 CC |
| 11952 | INJECTION OF FILLING MATERIAL UNDER SKIN, 5.1-10.0 CC |
| 11954 | INJECTION OF FILLING MATERIAL UNDER SKIN, MORE THAN 10.0 CC |
| 15769 | SELF SOFT TISSUE GRAFT |
| 15771 | GRAFT USING PATIENT'S FAT REMOVED BY LIPOSUCTION AND INSERTED INTO TRUNK, BREASTS, SCALP, ARMS, OR LEGS, 50.0 CC OR LESS |
| 15772 | GRAFT USING PATIENT'S FAT REMOVED BY LIPOSUCTION AND INSERTED INTO TRUNK, BREASTS, SCALP, ARMS, OR LEGS, EACH ADDITIONAL 50.0 CC |
| 15773 | GRAFT USING PATIENT'S FAT REMOVED BY LIPOSUCTION AND INSERTED INTO FACE, EYELIDS, MOUTH, NECK, EARS, AROUND EYES, GENITALS, HANDS, OR FEET, 25.0 CC OR LESS |
| 15774 | GRAFT USING PATIENT'S FAT REMOVED BY LIPOSUCTION AND INSERTED INTO FACE, EYELIDS, MOUTH, NECK, EARS, AROUND EYES, GENITALS, HANDS, OR FEET, EACH ADDITIONAL 25.0 CC |
| 15775 | HAIR TRANSPLANT, 1-15 PUNCH GRAFTS |
| 15776 | HAIR TRANSPLANT, MORE THAN 15 PUNCH GRAFTS |
| 15780 | DERMABRASION OF SKIN OF TOTAL FACE |
| 15781 | REPAIR OF DETACHED RETINA, 1 OR MORE SESSIONS |
| 15782 | DERMABRASION OF SKIN OTHER THAN FACE |
| 15783 | DERMABRASION OF SUPERFICIAL SCARS OR TATTOOS FROM SKIN |
| 15786 | SCRAPING OF SKIN GROWTH, FIRST GROWTH |
| 15787 | SCRAPING OF SKIN GROWTH, EACH ADDITIONAL 1-4 GROWTHS |
| 15788 | CHEMICAL PEEL OF OUTER LAYER OF SKIN OF FACE |
| 15789 | CHEMICAL PEEL OF DEEP LAYER OF SKIN OF FACE |
| 15792 | CHEMICAL PEEL OF OUTER LAYER OF NONFACIAL SKIN |
| 15793 | CHEMICAL PEEL OF DEEP LAYER OF NONFACIAL SKIN |
| 15810 | SALABRASION; 20 SQ CM OR LESS |
| 15811 | SALABRASION; OVER 20 SQ CM |
| 15819 | REMOVAL OF EXTRA SKIN OF NECK |
| 15820 | REPAIR OF LOWER EYELID DEFECT |
| 15821 | REMOVAL OF EXCESSIVE SKIN OF LOWER EYELID AND FAT AROUND EYE |
| 15822 | REMOVAL OF EXCESSIVE SKIN OF UPPER EYELID |
| 15823 | REMOVAL OF EXCESSIVE SKIN AND FAT OF UPPER EYELID |
| 15824 | REMOVAL OF WRINKLES AND EXTRA SKIN OF FOREHEAD |
| 15825 | REMOVAL OF WRINKLES AND EXTRA SKIN OF NECK |
| 15826 | INCISION, STRETCHING, AND SUTURE OF SKIN BETWEEN EYEBROWS |
| 15828 | REMOVAL OF WRINKLES AND EXTRA SKIN OF CHEEKS, CHIN, AND NECK |
| 15829 | REMOVAL OF WRINKLES AND EXTRA SKIN WITH GRAFTING OF CHEEKS, CHIN, AND NECK |
| 15830 | REMOVAL OF EXTRA SKIN AND TISSUE OF ABDOMEN |
| 15831 | EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); ABDOMEN |
| 15832 | REMOVAL OF EXTRA SKIN AND TISSUE OF THIGH |
| 15833 | REMOVAL OF EXTRA SKIN AND TISSUE OF LEG |
| 15834 | REMOVAL OF EXTRA SKIN AND TISSUE OF HIP |
| 15835 | REMOVAL OF EXTRA SKIN AND TISSUE OF BUTTOCK |
| 15836 | REMOVAL OF EXTRA SKIN AND TISSUE OF ARM |
| 15837 | REMOVAL OF EXTRA SKIN AND TISSUE OF FOREARM OR HAND |
| 15838 | REMOVAL OF EXTRA SKIN AND TISSUE OF CHIN |
| 15839 | REMOVAL OF EXTRA SKIN AND TISSUE OF OTHER AREA |
| 15847 | EXTENSIVE REMOVAL OF EXTRA SKIN AND TISSUE OF ABDOMEN |
| 15876 | SUCTION ASSISTED REMOVAL OF FAT OF HEAD AND NECK |
| 15877 | SUCTION ASSISTED REMOVAL OF FAT OF BODY |
| 15878 | SUCTION ASSISTED REMOVAL OF FAT OF ARM |
| 15879 | SUCTION ASSISTED REMOVAL OF FAT OF LEG |
| 17380 | HAIR REMOVAL BY ELECTROLYSIS, EACH 30 MINUTES |
| 19316 | REPAIR FOR SAGGING OF THE BREAST |
| 21120 | IMPLANTATION OF GRAFT TO ENLARGE CHIN BONE |
| 21123 | INSERTION OF SLIDING BONE GRAFT TO ENLARGE CHIN BONE, ADDITIONAL BONE GRAFT |
| 21193 | RECONSTRUCTION OF MANDIBULAR RAMI, HORIZONTAL, VERTICAL, C, OR L OSTEOTOMY; |
| 21208 | OSTEOPLASTY, FACIAL BONES; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, OR PROSTHETIC |
| 21209 | OSTEOPLASTY, FACIAL BONES; REDUCTION |
| 21270 | MALAR AUGMENTATION, PROSTHETIC MATERIAL |
| 30400 | RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/OR ELEVATION OF NASAL TIP |
| 30410 | RESHAPING OF BONE, CARTILAGE, AND/OR TIP OF NOSE |
| 30420 | RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR |
| 30430 | REVISION TO RESHAPE NOSE OR SMALL AMOUNT OF TIP OF NOSE AFTER PREVIOUS REPAIR |
| 30435 | RHINOPLASTY, SECONDARY; INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES) |
| 30450 | RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK AND OSTEOTOMIES) |
| 30462 | REVISION OF CONGENITAL NASAL DEFECT WITH LENGTHENING OF TIP OF NOSE |
| 30465 | REPAIR OF NASAL PASSAGE |
| 30468 | REPAIR OF COLLAPSED NOSTRIL USING IMPLANT IN SIDE OF NOSE |
| 31588 | GENERAL REPAIR OF VOICE BOX |
| 37788 | RESTORATION OF BLOOD FLOW IN ARTERY OF PENIS |
| 37790 | BLOCKAGE OF PENIS VEIN |
| 40500 | VERMILIONECTOMY (LIP SHAVE), WITH MUCOSAL ADVANCEMENT |
| 54400 | INSERTION OF NON-INFLATABLE PENILE IMPLANT |
| 54401 | INSERTION OF INFLATABLE PENILE IMPLANT |
| 54405 | INSERTION OF MULTICOMPONENT INFLATABLE PENILE IMPLANT |
| 54408 | REPAIR OF MULTICOMPONENT INFLATABLE PENILE IMPLANT |
| 54410 | REMOVAL AND REPLACEMENT OF MULTICOMPONENT INFLATABLE PENILE IMPLANT DURING SAMESURGERY |
| 54411 | REMOVAL AND REPLACEMENT OF INFECTED COMPONENTS OF INFLATABLE PENILE IMPLANT |
| 54416 | REMOVAL AND REPLACEMENT OF NONINFLATABLE PENILE IMPLANT |
| 54417 | REMOVAL AND REPLACEMENT OF INFECTED NONINFLATABLE PENILE IMPLANT |
| 67820 | REMOVAL OF EYELASHES USING FORCEPS |
| 67825 | CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY |
| 67900 | REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH) |
| 70336 | MRI SCAN OF JAW JOINT |
| 70450 | CT SCAN HEAD OR BRAIN WITHOUT CONTRAST |
| 70460 | COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S) |
| 70470 | CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST |
| 70480 | CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST |
| 70481 | COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR |
| 70482 | COMPUTED TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS |
| 70486 | CT SCAN OF FACE WITHOUT CONTRAST |
| 70487 | COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S) |
| 70488 | COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL, FOLLOWED BYCONTRAST MATERIAL(S) AND FURTHER SECTIONS |
| 70490 | CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST |
| 70491 | CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST |
| 70492 | CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST |
| 70496 | CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST |
| 70498 | CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST |
| 70540 | MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK WITHOUT CONTRAST |
| 70542 | MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK WITH CONTRAST |
| 70543 | MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST |
| 70544 | MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST |
| 70545 | MRI SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST |
| 70546 | MRI SCAN OF BLOOD VESSELS OF HEAD BEFORE AND AFTER CONTRAST |
| 70547 | MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST |
| 70548 | MRI SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST |
| 70549 | MRI SCAN OF BLOOD VESSELS OF NECK BEFORE AND AFTER CONTRAST |
| 70551 | MRI SCAN OF BRAIN WITHOUT CONTRAST |
| 70552 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST MATERIAL(S) |
| 70553 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES |
| 70555 | FUNCTIONAL MRI SCAN OF BRAIN WITH NEUROFUNCTIONAL TESTING |
| 71250 | CT SCAN OF CHEST WITHOUT CONTRAST |
| 71260 | CT SCAN OF CHEST WITH CONTRAST |
| 71270 | CT SCAN OF CHEST BEFORE AND AFTER CONTRAST |
| 71271 | LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING |
| 71275 | CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST |
| 71550 | MRI SCAN OF CHEST WITHOUT CONTRAST |
| 71551 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND |
| 71552 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR ANDMEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES |
| 71555 | MAGNETIC RESONANCE ANGIOGRAPHY, CHEST (EXCLUDING MYOCARDIUM), WITH OR WITHOUT |
| 72125 | CT SCAN OF UPPER SPINE WITHOUT CONTRAST |
| 72126 | COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL |
| 72127 | COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS |
| 72128 | CT SCAN OF MIDDLE SPINE WITHOUT CONTRAST |
| 72129 | COMPUTED TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL |
| 72130 | COMPUTED TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS |
| 72131 | CT SCAN OF LOWER SPINE WITHOUT CONTRAST |
| 72132 | COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL |
| 72133 | COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS |
| 72141 | MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST |
| 72142 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; |
| 72146 | MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST |
| 72147 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; |
| 72148 | MRI SCAN OF LOWER SPINAL CANAL WITHOUT CONTRAST |
| 72149 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; |
| 72156 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; CERVICAL |
| 72157 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; THORACIC |
| 72158 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR |
| 72159 | MRI SCAN OF BLOOD VESSELS OF SPINAL CANAL |
| 72191 | CT SCAN OF BLOOD VESSELS OF PELVIS WITH CONTRAST |
| 72192 | CT SCAN OF PELVIS WITHOUT CONTRAST |
| 72193 | CT SCAN OF PELVIS WITH CONTRAST |
| 72194 | COMPUTED TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS |
| 72195 | MRI SCAN OF PELVIS WITHOUT CONTRAST |
| 72196 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITH CONTRAST MATERIAL(S) |
| 72197 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), |
| 72198 | MRI SCAN OF BLOOD VESSELS OF PELVIS |
| 73200 | CT SCAN OF ARM WITHOUT CONTRAST |
| 73201 | COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) |
| 73202 | COMPUTED TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY |
| 73206 | CT SCAN OF BLOOD VESSELS OF ARM WITH CONTRAST |
| 73218 | MRI SCAN OF ARM WITHOUT CONTRAST |
| 73219 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; |
| 73220 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT; |
| 73221 | MRI SCAN OF ARM JOINT WITHOUT CONTRAST |
| 73222 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITH |
| 73223 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY; WITHOUT |
| 73225 | MRI SCAN OF BLOOD VESSELS OF ARM |
| 73700 | CT SCAN OF LEG WITHOUT CONTRAST |
| 73701 | CT SCAN OF LEG WITH CONTRAST MATERIAL |
| 73702 | CT SCAN OF LEG BEFORE AND AFTER CONTRAST |
| 73706 | CT SCAN OF BLOOD VESSELS OF LOWER LEG WITH CONTRAST |
| 73718 | MRI SCAN OF LEG WITHOUT CONTRAST |
| 73719 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; WITH |
| 73720 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY OTHER THAN JOINT; |
| 73721 | MRI SCAN OF LEG JOINT WITHOUT CONTRAST |
| 73722 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITH |
| 73723 | MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT |
| 73725 | MRI SCAN OF BLOOD VESSELS OF LEG |
| 74150 | CT SCAN OF ABDOMEN WITHOUT CONTRAST |
| 74160 | CT SCAN OF ABDOMEN WITH CONTRAST |
| 74170 | CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST |
| 74174 | CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST |
| 74175 | CT SCAN OF BLOOD VESSELS OF ABDOMEN WITH CONTRAST |
| 74176 | CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST |
| 74177 | CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST |
| 74178 | CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST |
| 74181 | MRI SCAN OF ABDOMEN WITHOUT CONTRAST |
| 74182 | MRI SCAN OF ABDOMEN WITH CONTRAST |
| 74183 | MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST |
| 74185 | MRI SCAN OF BLOOD VESSELS OF ABDOMEN |
| 74261 | DIAGNOSTIC CT SCAN OF LARGE INTESTINE WITHOUT CONTRAST |
| 74262 | DIAGNOSTIC CT SCAN OF LARGE INTESTINE WITH CONTRAST |
| 74263 | SCREENING CT SCAN OF LARGE INTESTINE |
| 74712 | MRI SCAN OF FETUS FOR SINGLE OR FIRST PREGNANCY |
| 74713 | MRI SCAN OF FETUS FOR EACH ADDITIONAL PREGNANCY |
| 75557 | MRI SCAN OF HEART WITHOUT CONTRAST |
| 75559 | MRI SCAN OF HEART WITHOUT CONTRAST WITH STRESS IMAGING |
| 75561 | MRI SCAN OF HEART BEFORE AND AFTER CONTRAST |
| 75563 | MRI SCAN OF HEART BEFORE AND AFTER CONTRAST WITH STRESS IMAGING |
| 75565 | MRI SCAN OF BLOOD FLOW OF HEART |
| 75574 | CT SCAN OF BLOOD VESSELS AND GRAFTS OF HEART WITH CONTRAST |
| 75635 | COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMINAL AORTA AND BILATERAL ILIOFEMORAL LOWER EXTREMITY RUNOFF, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING |
| 76380 | LIMITED OR FOLLOW-UP CT SCAN |
| 77046 | MRI SCAN OF 1 BREAST WITHOUT CONTRAST |
| 77047 | MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST |
| 77048 | MRI SCAN OF 1 BREAST |
| 77049 | MRI SCAN OF BOTH BREASTS |
| 77058 | MRI SCAN OF ONE BREAST WITH CONTRAST |
| 77059 | MRI SCAN OF BOTH BREASTS WITH CONTRAST |
| 77084 | MRI SCAN OF BONE MARROW |
| 78429 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE WITH METABOLIC EVALUATION AND CONCURRENTCT SCAN |
| 78430 | NUCLEAR MEDICINE STUDY OF BLOOD FLOW IN HEART MUSCLE AT REST AND WITH STRESS WITH CONCURRENT CT SCAN |
| 78431 | NUCLEAR MEDICINE STUDIES OF BLOOD FLOW IN HEART MUSCLE AT REST AND WITH STRESS WITH CONCURRENT CT SCAN |
| 78432 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE WITH METABOLIC AND BLOOD FLOW EVALUATIONREQUIRING 2 INJECTIONS |
| 78433 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE WITH METABOLIC AND BLOOD FLOW EVALUATIONREQUIRING 2 INJECTIONS AND CONCURRENT CT SCAN |
| 78451 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE AT REST AND WITH STRESS AND SPECT |
| 78452 | NUCLEAR MEDICINE STUDIES OF HEART MUSCLE AT REST AND WITH STRESS AND SPECT |
| 78453 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE AT REST AND WITH STRESS WITH SINGLE 2D IMAGE |
| 78454 | NUCLEAR MEDICINE STUDIES OF HEART MUSCLE AT REST AND WITH STRESS WITH SINGLE 2DIMAGE |
| 78459 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE WITH METABOLIC EVALUATION |
| 78466 | MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE |
| 78468 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE FOLLOWING HEART ATTACK WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT |
| 78469 | NUCLEAR MEDICINE STUDY OF HEART MUSCLE FOLLOWING HEART ATTACK WITH SPECT |
| 78472 | NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION BY LABELING RED BLOOD CELLS WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER MULTIPLECYCLES |
| 78473 | NUCLEAR MEDICINE STUDIES OF HEART PUMPING FUNCTION BY LABELING RED BLOOD CELLS WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER MULTIPLECYCLES |
| 78481 | NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER A SINGLE CYCLE |
| 78483 | NUCLEAR MEDICINE STUDIES OF HEART PUMPING FUNCTION BY FIRST PASS TECHNIQUE WITHMEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER A SINGLE CYCL |
| 78491 | NUCLEAR MEDICINE STUDY OF BLOOD FLOW IN HEART MUSCLE AT REST AND WITH STRESS |
| 78492 | NUCLEAR MEDICINE STUDIES OF BLOOD FLOW IN HEART MUSCLE AT REST AND WITH STRESS |
| 78494 | NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION BY LABELING RED BLOOD CELLS WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER MULTIPLECYCLES WITH SPECT |
| 78496 | NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION OVER SINGLE CYCLE |
| 78608 | NUCLEAR MEDICINE STUDY OF BRAIN WITH METABOLIC EVALUATION |
| 78609 | NUCLEAR MEDICINE STUDY OF BRAIN WITH BLOOD FLOW EVALUATION |
| 78811 | POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; LIMITED AREA (EG, CHEST, HEAD/NECK) |
| 78812 | NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH |
| 78813 | NUCLEAR MEDICINE STUDY WHOLE BODY |
| 78814 | NUCLEAR MEDICINE STUDY LIMITED AREA WITH CT SCAN |
| 78815 | NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN |
| 78816 | NUCLEAR MEDICINE STUDY WHOLE BODY WITH CT SCAN |
| 92065 | EYE TRAINING EXERCISE PERFORMED BY HEALTH CARE PROFESSIONAL |
| A4211 | SUPPLIES FOR SELF ADMINISTERED |
| A4222 | INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS SEPARATELY) |
| A4223 | INFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION PUMP, PER CASSETTE OR BAG (LIST DRUGS SEPARATELY) |
| A4239 | SUPPLY ALLOWANCE FOR NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALL SUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE |
| A4265 | PARAFFIN, PER POUND |
| A4305 | DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR |
| A4306 | DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF LESS THAN 50 ML PER HOUR |
| A4335 | INCONTINENCE SUPPLY MISC |
| A4352 | INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, OR SILICONE ELASTOMERIC, ETC.), EACH |
| A4421 | OSTOMY SUPPLY; MISCELLANEOUS |
| A4453 | RECTAL CATHETER WITH OR WITHOUT BALLOON, FOR USE WITH ANY TYPE TRANSANAL IRRIGATION SYSTEM, EACH |
| A4457 | ENEMA TUBE, WITH OR WITHOUT ADAPTER, ANY TYPE, REPLACEMENT ONLY, EACH |
| A4459 | MANUAL TRANSANAL IRRIGATION SYSTEM, INCLUDES WATER RESERVOIR, PUMP, TUBING, ANDACCESSORIES, WITHOUT CATHETER, ANY TYPE |
| A4606 | OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, REPLACEMENT |
| A4632 | REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH |
| A4649 | SURGICAL SUPPLY MISC |
| A5149 | INCONTINENCE/OSTOMY SUPPLY MIS |
| A6261 | WOUND FILLER, GEL/PASTE, PER FLUID OUNCE, NOT OTHERWISE SPECIFIED |
| A6262 | WOUND FILLER, DRY FORM, PER GRAM, NOT OTHERWISE SPECIFIED |
| A6501 | COMPRESSION BURN GARMENT, BODYSUIT (HEAD TO FOOT), CUSTOM FABRICATED |
| A6502 | COMPRESSION BURN GARMENT, CHIN STRAP, CUSTOM FABRICATED |
| A6503 | COMPRESSION BURN GARMENT, FACIAL HOOD, CUSTOM FABRICATED |
| A6504 | COMPRESSION BURN GARMENT, GLOVE TO WRIST, CUSTOM FABRICATED |
| A6505 | COMPRESSION BURN GARMENT, GLOVE TO ELBOW, CUSTOM FABRICATED |
| A6506 | COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED |
| A6507 | COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED |
| A6508 | COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED |
| A6509 | COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST), CUSTOM FABRICATED |
| A6510 | COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD), CUSTOM FABRICATED |
| A6511 | COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM FABRICATED |
| A6512 | COMPRESSION BURN GARMET NOC |
| A6519 | GRADIENT COMPRESSION GARMENT, NOT OTHERWISE SPECIFIED, FOR NIGHTTIME USE, EACH |
| A6542 | GRADIENT COMPRESSION STOCKING, CUSTOM MADE |
| A6549 | GRADIENT COMPRESSION GARMENT, NOT OTHERWISE SPECIFIED, FOR DAYTIME USE, EACH |
| A6559 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, CUSTOM, EACH |
| A6560 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, CUSTOM, EACH |
| A6561 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40 MMHG OR GREATER, CUSTOM, EACH |
| A6584 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, NOT OTHERWISE SPECIFIED |
| A8004 | SOFT INTERFACE FOR HELMET, REPLACEMENT ONLY |
| A9277 | TRANSMITTER; EXTERNAL, FOR USE WITH NON-DURABLE MEDICAL EQUIPMENT INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM |
| A9278 | RECEIVER (MONITOR); EXTERNAL, FOR USE WITH NON-DURABLE MEDICAL EQUIPMENT INTERSTITIAL CONTINUOUS GLUCOSE MONITORING SYSTEM |
| A9282 | WIG, ANY TYPE, EACH |
| A9900 | MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS CODE |
| A9999 | MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED |
| B4085 | GASTRONOMY TUBE SILICONE W/SLI |
| B4105 | IN-LINE CARTRIDGE CONTAINING DIGESTIVE ENZYME(S) FOR ENTERAL FEEDING, EACH |
| B4220 | PARENTERAL NUT SUPPLY KIT;PREM |
| B4222 | PARENTERAL NUT SUPPLY KIT;HOME |
| B4224 | PARENTERAL NUT ADMINISTRATION |
| B9998 | NOC FOR ENTERAL SUPPLIES |
| B9999 | NOT OTHERWISE CLASSIFIED PAREN |
| D0360 | CONE BEAM CT - CRANIOFACIAL DATA CAPTURE |
| D0364 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH LIMITED FIELD OF VIEW - LESS THAN ONE WHOLE JAW |
| D0365 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MANDIBLE |
| D0366 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF ONE FULL DENTAL ARCH - MAXILLA, WITH OR WITHOUT CRANIUM |
| D0367 | CONE BEAM CT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW OF BOTH JAWS, WITH OR WITHOUT CRANIUM |
| D0368 | CONE BEAM CT CAPTURE AND INTERPRETATION FOR TMJ SERIES INCLUDING TWO OR MORE EXPOSURES |
| D2710 | CROWN - RESIN-BASED COMPOSITE (INDIRECT) |
| D2720 | CROWN-RESIN WITH HIGH NOBLE METAL |
| D2721 | CROWN-RESIN WITH PREDOMINANTLY BASE METAL |
| D2722 | CROWN-RESIN WITH NOBLE METAL |
| D2740 | CROWN - PORCELAIN/CERAMIC |
| D2750 | CROWN-PORCELAIN FUSED TO HIGH NOBLE METAL |
| D2751 | CROWN-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL |
| D2752 | CROWN-PORCELAIN FUSED TO NOBLE METAL |
| D2753 | CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D2780 | CROWN - 3/4 CAST HIGH NOBLE METAL |
| D2781 | CROWN - 3/4 CAST PREDOMINANTLY BASE METAL |
| D2782 | CROWN - 3/4 CAST NOBLE METAL |
| D2790 | CROWN-FULL CAST HIGH NOBLE METAL |
| D2791 | CROWN-FULL CAST PREDOMINANTLY BASE METAL |
| D2792 | CROWN-FULL CAST NOBLE METAL |
| D2794 | CROWN - TITANIUM AND TITANIUM ALLOYS |
| D3230 | PULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION) |
| D3240 | PULPAL THERAPY (RESORBABLE FILLING)-POSTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION) |
| D3310 | ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION) |
| D3320 | ENDODONTIC THERAPY, PREMOLAR TOOTH (EXCLUDING FINAL RESTORATION) |
| D3330 | ENDODONTIC THERAPY, MOLAR TOOTH (EXCLUDING FINAL RESTORATION) |
| D3346 | RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-ANTERIOR |
| D3347 | RETREATMENT OF PREVIOUS ROOT CANAL THERAPY - PREMOLAR |
| D3348 | RETREATMENT OF PREVIOUS ROOT CANAL THERAPY-MOLAR |
| D3410 | APICOECTOMY - ANTERIOR |
| D3421 | APICOECTOMY - PREMOLAR (FIRST ROOT) |
| D3425 | APICOECTOMY - MOLAR (FIRST ROOT) |
| D3426 | APICOECTOMY (EACH ADDITIONAL ROOT) |
| D3430 | RETROGRADE FILLING-PER ROOT |
| D4245 | APICALLY POSITIONED FLAP |
| D4249 | CLINICAL CROWN LENGTHENING-HARD TISSUE |
| D4266 | GUIDED TISSUE REGENERATION, NATURAL TEETH - RESORBABLE BARRIER, PER SITE |
| D4267 | GUIDED TISSUE REGENERATION, NATURAL TEETH - NON-RESORBABLE BARRIER, PER SITE |
| D4273 | AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT |
| D4275 | NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT (INCLUDING RECIPIENT SITE AND DONOR MATERIAL) FIRST TOOTH, IMPLANT, OR EDENTULOUS TOOTH POSITION IN GRAFT |
| D4277 | FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES), FIRST TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN GRAFT |
| D4278 | FREE SOFT TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT AND DONOR SURGICAL SITES), EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE |
| D4283 | AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING DONOR AND RECIPIENT SURGICAL SITES) - EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTHPOSITION IN SAME GRAFT SITE |
| D4285 | NON-AUTOGENOUS CONNECTIVE TISSUE GRAFT PROCEDURE (INCLUDING RECIPIENT SURGICAL SITE AND DONOR MATERIAL) - EACH ADDITIONAL CONTIGUOUS TOOTH, IMPLANT OR EDENTULOUS TOOTH POSITION IN SAME GRAFT SITE |
| D5110 | COMPLETE DENTURE - MAXILLARY |
| D5120 | COMPLETE DENTURE - MANDIBULAR |
| D5211 | MAXILLARY PARTIAL DENTURE - RESIN BASE (INCLUDING, RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH) |
| D5212 | MANDIBULAR PARTIAL DENTURE - RESIN BASE (INCLUDING, RETENTIVE/CLASPING MATERIALS, RESTS AND TEETH) |
| D5213 | MAXILLARY PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING RETENTIVE/CLASPING MATERIALS, RESTS AND TEETH) |
| D5214 | MANDIBULAR PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN DENTURE BASES (INCLUDING RETENTIVE/CLASPING MATERIALS,RESTS AND TEETH) |
| D5225 | MAXILLARY PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH) |
| D5226 | MANDIBULAR PARTIAL DENTURE - FLEXIBLE BASE (INCLUDING RETENTIVE/CLASPING MATERIALS, RESTS, AND TEETH) |
| D5710 | REBASE COMPLETE MAXILLARY DENTURE |
| D5711 | REBASE COMPLETE MANDIBULAR DENTURE |
| D5720 | REBASE MAXILLARY PARTIAL DENTURE |
| D5721 | REBASE MANDIBULAR PARTIAL DENTURE |
| D5730 | RELINE COMPLETE MAXILLARY DENTURE (DIRECT) |
| D5731 | RELINE LOWER COMPLETE MANDIBULAR DENTURE (DIRECT) |
| D5740 | RELINE MAXILLARY PARTIAL DENTURE (DIRECT) |
| D5741 | RELINE MANDIBULAR PARTIAL DENTURE (DIRECT) |
| D6010 | SURGICAL PLACEMENT OF IMPLANT BODY: ENDOSTEAL IMPLANT |
| D6013 | SURGICAL PLACEMENT OF MINI IMPLANT |
| D6052 | SEMI-PRECISION ATTACHMENT ABUTMENT |
| D6055 | CONNECTING BAR - IMPLANT SUPPORTED OR ABUTMENT SUPPORTED |
| D6056 | PREFABRICATED ABUTMENT - INCLUDES MODIFICATION AND PLACEMENT |
| D6057 | CUSTOM FABRICATED ABUTMENT - INCLUDES PLACEMENT |
| D6058 | ABUTMENT SUPPORTED PORCELAIN/CERAMIC CROWN |
| D6059 | ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (HIGH NOBLE METAL) |
| D6060 | ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (PREDOMINANTLY BASE METAL) |
| D6061 | ABUTMENT SUPPORTED PORCELAIN FUSED TO METAL CROWN (NOBLE METAL) |
| D6062 | ABUTMENT SUPPORTED CAST METAL CROWN (HIGH NOBLE METAL) |
| D6063 | ABUTMENT SUPPORTED CAST METAL CROWN (PREDOMINANTLY BASE METAL) |
| D6064 | ABUTMENT SUPPORTED CAST METAL CROWN (NOBLE METAL) |
| D6065 | IMPLANT SUPPORTED PORCELAIN/CERAMIC CROWN |
| D6066 | IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO HIGH NOBLE ALLOYS |
| D6067 | IMPLANT SUPPORTED CROWN - HIGH NOBLE ALLOYS |
| D6068 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN/CERAMIC FPD |
| D6069 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (HIGH NOBLE METAL) |
| D6070 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (PREDOMINANTLY BASE METAL) |
| D6071 | ABUTMENT SUPPORTED RETAINER FOR PORCELAIN FUSED TO METAL FPD (NOBLE METAL) |
| D6072 | ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (HIGH NOBLE METAL) |
| D6073 | ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (PREDOMINANTLY BASE METAL) |
| D6074 | ABUTMENT SUPPORTED RETAINER FOR CAST METAL FPD (NOBLE METAL) |
| D6075 | IMPLANT SUPPORTED RETAINER FOR CERAMIC FPD |
| D6076 | IMPLANT SUPPORTED RETAINER FOR FPD - PORCELAIN FUSED TO HIGH NOBLE ALLOYS |
| D6077 | IMPLANT SUPPORTED RETAINER FOR METAL FPD - HIGH NOBLE ALLOYS |
| D6082 | IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE ALLOYS |
| D6083 | IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO NOBLE ALLOYS |
| D6084 | IMPLANT SUPPORTED CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D6086 | IMPLANT SUPPORTED CROWN - PREDOMINANTLY BASE ALLOYS |
| D6087 | IMPLANT SUPPORTED CROWN - NOBLE ALLOYS |
| D6088 | IMPLANT SUPPORTED CROWN - TITANIUM AND TITANIUM ALLOYS |
| D6094 | ABUTMENT SUPPORTED CROWN - TITANIUM AND TITANIUM ALLOYS |
| D6097 | ABUTMENT SUPPORTED CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D6098 | IMPLANT SUPPORTED RETAINER - PORCELAIN FUSED TO PREDOMINANTLY BASE ALLOYS |
| D6099 | IMPLANT SUPPORTED RETAINER FOR FPD - PORCELAIN FUSED TO NOBLE ALLOYS |
| D6101 | DEBRIDEMENT OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT, AND SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE |
| D6102 | DEBRIDEMENT AND OSSEOUS CONTOURING OF A PERI-IMPLANT DEFECT OR DEFECTS SURROUNDING A SINGLE IMPLANT AND INCLUDES SURFACE CLEANING OF THE EXPOSED IMPLANT SURFACES, INCLUDING FLAP ENTRY AND CLOSURE |
| D6103 | BONE GRAFT FOR REPAIR OF PERI-IMPLANT DEFECT - DOES NOT INCLUDE FLAP ENTRY AND CLOSURE |
| D6104 | BONE GRAFT AT TIME OF IMPLANT PLACEMENT |
| D6106 | GUIDED TISSUE REGENERATION - RESORBABLE BARRIER, PER IMPLANT |
| D6110 | IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MAXILLARY |
| D6111 | IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR EDENTULOUS ARCH - MANDIBULAR |
| D6112 | IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY |
| D6113 | IMPLANT/ABUTMENT SUPPORTED REMOVABLE DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR |
| D6114 | IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR EDENTULOUS ARCH - MAXILLARY |
| D6115 | IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR EDENTULOUS ARCH - MANDIBULAR |
| D6116 | IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH - MAXILLARY |
| D6117 | IMPLANT/ABUTMENT SUPPORTED FIXED DENTURE FOR PARTIALLY EDENTULOUS ARCH - MANDIBULAR |
| D6120 | IMPLANT SUPPORTED RETAINER - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D6121 | IMPLANT SUPPORTED RETAINER FOR METAL FPD - PREDOMINANTLY BASE ALLOYS |
| D6122 | IMPLANT SUPPORTED RETAINER FOR METAL FPD - NOBLE ALLOYS |
| D6123 | IMPLANT SUPPORTED RETAINER FOR METAL FPD - TITANIUM AND TITANUM ALLOYS |
| D6191 | SEMI-PRECISION ABUTMENT - PLACEMENT |
| D6192 | SEMI-PRECISION ATTACHMENT - PLACEMENT |
| D6194 | ABUTMENT SUPPORTED RETAINER CROWN FOR FPD - TITANIUM AND TITANIUM ALLOYS |
| D6195 | ABUTMENT SUPPORTED RETAINER - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D6210 | PONTIC-CAST HIGH NOBLE METAL |
| D6211 | PONTIC-CAST PREDOMINANTLY BASE METAL |
| D6212 | PONTIC-CAST NOBLE METAL |
| D6214 | PONTIC - TITANIUM AND TITANIUM ALLOYS |
| D6240 | PONTIC-PORCELAIN FUSED TO HIGH NOBLE METAL |
| D6241 | PONTIC-PORCELAIN FUSED TO PREDOMINANTLY BASE METAL |
| D6242 | PONTIC-PORCELAIN FUSED TO NOBLE METAL |
| D6243 | PONTIC - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D6245 | PONTIC - PORCELAIN/CERAMIC |
| D6250 | PONTIC-RESIN WITH HIGH NOBLE METAL |
| D6251 | PONTIC-RESIN WITH PREDOMINANTLY BASE METAL |
| D6252 | PONTIC-RESIN WITH NOBLE METAL |
| D6545 | RETAINER-CAST METAL FOR RESIN BONDED FIXED PROSTHESIS |
| D6720 | RETAINER CROWN-RESIN WITH HIGH NOBLE METAL |
| D6721 | RETAINER CROWN-RESIN WITH PREDOMINANTLY BASE METAL |
| D6722 | RETAINER CROWN - RESIN WITH NOBLE METAL |
| D6740 | RETAINER CROWN - PORCELAIN/CERAMIC |
| D6750 | RETAINER CROWN - PORCELAIN FUSED TO HIGH NOBLE METAL |
| D6751 | RETAINER CROWN - PORCELAIN FUSED TO PREDOMINANTLY BASE METAL |
| D6752 | RETAINER CROWN - PORCELAIN FUSED TO NOBLE METAL |
| D6753 | RETAINER CROWN - PORCELAIN FUSED TO TITANIUM AND TITANIUM ALLOYS |
| D6780 | RETAINER CROWN - 3/4 CAST HIGH NOBLE METAL |
| D6781 | RETAINER CROWN - 3/4 CAST PREDOMINANTLY BASED METAL |
| D6782 | RETAINER CROWN - 3/4 CAST NOBLE METAL |
| D6783 | RETAINER CROWN - 3/4 PORCELAIN/CERAMIC |
| D6784 | RETAINER CROWN 3/4 - TITANIUM AND TITANIUM ALLOYS |
| D6790 | RETAINER CROWN - FULL CAST HIGH NOBLE METAL |
| D6791 | RETAINER CROWN - FULL CAST PREDOMINANTLY BASE METAL |
| D6792 | RETAINER CROWN - FULL CAST NOBLE METAL |
| D6794 | RETAINER CROWN - TITANIUM AND TITANIUM ALLOYS |
| D7220 | REMOVAL OF IMPACTED TOOTH-SOFT TISSUE |
| D7230 | REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY |
| D7240 | REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY |
| D7290 | SURGICAL REPOSITIONING OF TEETH |
| D7340 | VESTIBULOPLASTY-RIDGE EXTENSION (SECOND EPITHELIALIZATION) |
| D7350 | VESTIBULOPLASTY-RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE RE-ATTACHMENTS, REVISION OF SOFT TISSUE ATTACHMENT, AND MANAGEMENT OF HYPERTROPHIED AND HYPERPLASTIC TISSUE) |
| D7951 | SINUS AUGMENTATION WITH BONE OR BONE SUBSTITUTES VIA A LATERAL OPEN APPROACH |
| D7952 | SINUS AUGMENTATION VIA A VERTICAL APPROACH |
| D7953 | BONE REPLACEMENT GRAFT FOR RIDGE PRESERVATION - PER SITE |
| D8070 | COMPREHENSIVE ORTHODONTIC TREATMENT OF THE TRANSITIONAL DENTITION |
| D8080 | COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADOLESCENT DENTITION |
| D8090 | COMPREHENSIVE ORTHODONTIC TREATMENT OF THE ADULT DENTITION |
| D8670 | PERIODIC ORTHODONTIC TREATMENT VISIT |
| D8680 | ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF RETAINER(S)) |
| E0140 | WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HEIGHT, ANY TYPE |
| E0192 | LOW PRESSURE/EQUALIZATION PAD |
| E0235 | PARAFFIN BATH UNIT, PORTABLE (SEE MEDICAL SUPPLY CODE A4265 FOR PARAFFIN) |
| E0277 | POWERED PRESSURE-REDUCING AIR MATTRESS |
| E0316 | SAFETY ENCLOSURE FRAME/CANOPY FOR USE WITH HOSPITAL BED, ANY TYPE |
| E0445 | OXIMETER DEVICE FOR MEASURING BLOOD OXYGEN LEVELS NON-INVASIVELY |
| E0637 | COMBINATION SIT TO STAND FRAME/TABLE SYSTEM, ANY SIZE INCLUDING PEDIATRIC, WITHSEAT LIFT FEATURE, WITH OR WITHOUT WHEELS |
| E0641 | STANDING FRAME/TABLE SYSTEM, MULTI-POSITION (E.G. THREE-WAY STANDER), ANY SIZE INCLUDING PEDIATRIC, WITH OR WITHOUT WHEELS |
| E0642 | STANDING FRAME/TABLE SYSTEM, MOBILE (DYNAMIC STANDER), ANY SIZE INCLUDING PEDIATRIC |
| E0651 | PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITHOUT CALIBRATED GRADIENT PRESSURE |
| E0652 | PNEUMATIC COMPRESSOR, SEGMENTAL HOME MODEL WITH CALIBRATED GRADIENT PRESSURE |
| E0720 | TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, TWO LEAD, LOCALIZED STIMULATION |
| E0766 | ELECTRICAL STIMULATION DEVICE USED FOR CANCER TREATMENT, INCLUDES ALL ACCESSORIES, ANY TYPE |
| E0784 | EXTERNAL AMBULATORY INFUSION PUMP, INSULIN |
| E0958 | MANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHMENT, EACH |
| E0980 | SAFETY VEST,WHEELCHAIR |
| E0986 | MANUAL WHEELCHAIR ACCESSORY, POWER ASSIST SYSTEM |
| E1002 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, TILT ONLY |
| E1003 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITHOUT SHEAR REDUCTION |
| E1004 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, RECLINE ONLY, WITH MECHANICAL SHEAR REDUCTION |
| E1005 | WHEELCHAIR ACCESSORY, POWER SEATNG SYSTEM, RECLINE ONLY, WITH POWER SHEAR REDUCTION |
| E1006 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITHOUT SHEAR REDUCTION |
| E1007 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH MECHANICAL SHEAR REDUCTION |
| E1008 | WHEELCHAIR ACCESSORY, POWER SEATING SYSTEM, COMBINATION TILT AND RECLINE, WITH POWER SHEAR REDUCTION |
| E1009 | WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, MECHANICALLY LINKED LEG ELEVATION SYSTEM, INCLUDING PUSHROD AND LEG REST, EACH |
| E1010 | WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, POWER LEG ELEVATION SYSTEM, INCLUDING LEG REST, PAIR |
| E1011 | MODIFICATION TO PEDIATRIC SIZE WHEELCHAIR, WIDTH ADJUSTMENT PACKAGE (NOT TO BE DISPENSED WITH INITIAL CHAIR) |
| E1012 | WHEELCHAIR ACCESSORY, ADDITION TO POWER SEATING SYSTEM, CENTER MOUNT POWER ELEVATING LEG REST/PLATFORM, COMPLETE SYSYTEM, ANY TYPE EACH |
| E1013 | PEDIATRIC WHEELCHAIR,CONTOURED |
| E1028 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE, OTHER |
| E1029 | WHEELCHAIR ACCESSORY, VENTILATOR TRAY, FIXED |
| E1032 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE USED WITH JOYSTICK OR OTHER DRIVE CONTROL INTERFACE |
| E1033 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE FOR HEADREST, CUSHIONED, ANY TYPE |
| E1034 | WHEELCHAIR ACCESSORY, MANUAL SWINGAWAY, RETRACTABLE OR REMOVABLE MOUNTING HARDWARE FOR LATERAL TRUNK OR HIP SUPPORT, ANY TYPE |
| E1220 | WHEELCHAIR SPECIALLY SIZED OR |
| E1225 | WHEELCHAIR ACCESSORY, MANUAL SEMI-RECLINING BACK, (RECLINE GREATER THAN 15 DEGREES, BUT LESS THAN 80 DEGREES), EACH |
| E1228 | SPECIAL BACK HEIGHT FOR WHEELCHAIR |
| E1229 | WHEELCHAIR, PEDIATRIC SIZE, NOT OTHERWISE SPECIFIED |
| E1236 | WHEELCHAIR, PEDIATRIC SIZE, FOLDING, ADJUSTABLE, WITH SEATING SYSTEM |
| E1298 | SPECIAL WHEELCHAIR SEAT DEPTH AND/OR WIDTH, BY CONSTRUCTION |
| E1399 | DURABLE MEDICAL EQUIPMENT,MISC |
| E1900 | AUGMENTAIVE COMMUNICATION DEVI |
| E2103 | NON-ADJUNCTIVE, NON-IMPLANTED CONTINUOUS GLUCOSE MONITOR OR RECEIVER |
| E2298 | COMPLEX REHABILITATIVE POWER WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM,ANY TYPE |
| E2300 | WHEELCHAIR ACCESSORY, POWER SEAT ELEVATION SYSTEM, ANY TYPE |
| E2301 | WHEELCHAIR ACCESSORY, POWER STANDING SYSTEM, ANY TYPE |
| E2310 | POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLERAND ONE POWER SEATING SYSTEM MOTOR, INCLUDING ALL RELATED ELECTRONICS, INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXED MOUNTING HARDWARE |
| E2311 | POWER WHEELCHAIR ACCESSORY, ELECTRONIC CONNECTION BETWEEN WHEELCHAIR CONTROLLERAND TWO OR MORE POWER SEATING SYSTEM MOTORS, INCLUDING ALL RELATED ELECTRONICS,INDICATOR FEATURE, MECHANICAL FUNCTION SELECTION SWITCH, AND FIXED MOUNTING HARDWARE |
| E2312 | POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, MINI-PROPORTIONAL REMOTE JOYSTICK, PROPORTIONAL, INCLUDING FIXED MOUNTING HARDWARE |
| E2313 | POWER WHEELCHAIR ACCESSORY, HARNESS FOR UPGRADE TO EXPANDABLE CONTROLLER, INCLUDING ALL FASTENERS, CONNECTORS AND MOUNTING HARDWARE, EACH |
| E2325 | POWER WHEELCHAIR ACCESSORY, SIP AND PUFF INTERFACE, NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, AND MANUAL SWINGAWAY MOUNTING HARDWARE |
| E2326 | POWER WHEELCHAIR ACCESSORY, BREATH TUBE KIT FOR SIP AND PUFF INTERFACE |
| E2327 | POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, MECHANICAL, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL DIRECTION CHANGE SWITCH, AND FIXED MOUNTING HARDWARE |
| E2328 | POWER WHEELCHAIR ACCESSORY, HEAD CONTROL OR EXTREMITY CONTROL INTERFACE, ELECTRONIC, PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS AND FIXED MOUNTING HARDWARE |
| E2329 | POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, CONTACT SWITCH MECHANISM, NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, MECHANICAL DIRECTION CHANGE SWITCH, HEAD ARRAY, AND FIXED MOUNTING HARDWARE |
| E2330 | POWER WHEELCHAIR ACCESSORY, HEAD CONTROL INTERFACE, PROXIMITY SWITCH MECHANISM, NONPROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS, MECHANICAL STOP SWITCH, MECHANICAL DIRECTION CHANGE SWITCH, HEAD ARRAY, AND FIXED MOUNTING HARDWARE |
| E2341 | POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME WIDTH, 24-27 INCHES |
| E2342 | POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 20 OR 21 INCHES |
| E2343 | POWER WHEELCHAIR ACCESSORY, NONSTANDARD SEAT FRAME DEPTH, 22-25 INCHES |
| E2373 | POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, COMPACT REMOTE JOYSTICK, PROPORTIONAL, INCLUDING FIXED MOUNTING HARDWARE |
| E2374 | POWER WHEELCHAIR ACCESSORY, HAND OR CHIN CONTROL INTERFACE, STANDARD REMOTE JOYSTICK (NOT INCLUDING CONTROLLER), PROPORTIONAL, INCLUDING ALL RELATED ELECTRONICS AND FIXED MOUNTING HARDWARE, REPLACEMENT ONLY |
| E2375 | POWER WHEELCHAIR ACCESSORY, NON-EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRONICS AND MOUNTING HARDWARE, REPLACEMENT ONLY |
| E2376 | POWER WHEELCHAIR ACCESSORY, EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRONICS AND MOUNTING HARDWARE, REPLACEMENT ONLY |
| E2377 | POWER WHEELCHAIR ACCESSORY, EXPANDABLE CONTROLLER, INCLUDING ALL RELATED ELECTRONICS AND MOUNTING HARDWARE, UPGRADE PROVIDED AT INITIAL ISSUE |
| E2378 | POWER WHEELCHAIR COMPONENT, ACTUATOR, REPLACEMENT ONLY |
| E2398 | WHEELCHAIR ACCESSORY, DYNAMIC POSITIONING HARDWARE FOR BACK |
| E2399 | POWER WHEELCHAIR ACCESSORY, NOT OTHERWISE CLASSIFIED INTERFACE, INCLUDING ALL RELATED ELECTRONICS AND ANY TYPE MOUNTING HARDWARE |
| E2510 | SPEECH GENERATING DEVICE, SYNTHESIZED SPEECH, PERMITTING MULTIPLE METHODS OF MESSAGE FORMULATION AND MULTIPLE METHODS OF DEVICE ACCESS |
| E2511 | SPEECH GENERATING SOFTWARE PROGRAM, FOR PERSONAL COMPUTER OR PERSONAL DIGITAL ASSISTANT |
| E2512 | ACCESSORY FOR SPEECH GENERATING DEVICE, MOUNTING SYSTEM |
| E2599 | ACCESSORY FOR SPEECH GENERATING DEVICE, NOT OTHERWISE CLASSIFIED |
| E2609 | CUSTOM FABRICATED WHEELCHAIR SEAT CUSHION, ANY SIZE |
| E2617 | CUSTOM FABRICATED WHEELCHAIR BACK CUSHION, ANY SIZE, INCLUDING ANY TYPE MOUNTING HARDWARE |
| E2621 | POSITIONING WHEELCHAIR BACK CUSHION, PLANAR BACK WITH LATERAL SUPPORTS, WIDTH 22 INCHES OR GREATER, ANY HEIGHT, INCLUDING ANY TYPE MOUNTING HARDWARE |
| E8000 | GAIT TRAINER, PEDIATRIC SIZE, POSTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND COMPONENTS |
| E8001 | GAIT TRAINER, PEDIATRIC SIZE, UPRIGHT SUPPORT, INCLUDES ALL ACCESSORIES AND COMPONENTS |
| E8002 | GAIT TRAINER, PEDIATRIC SIZE, ANTERIOR SUPPORT, INCLUDES ALL ACCESSORIES AND COMPONENTS |
| G0297 | LOW DOSE CT SCAN (LDCT) FOR LUNG CANCER SCREENING |
| J0270 | INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG |
| J0275 | ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG |
| J2440 | INJECTION, PAPAVERINE HCL, UP TO 60 MG |
| J2760 | INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG |
| K0009 | OTHER MANUAL WHEELCHAIR |
| K0056 | SEAT HEIGHT LESS THAN 17" OR EQUAL TO OR GREATER THAN 21" FOR A HIGH STRENGTH, LIGHTWEIGHT, OR ULTRALIGHTWEIGHT WHEELCHAIR |
| K0108 | WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED |
| K0115 | CUSTOM BACK FOR WHEELCHAIR,POS |
| K0116 | SEATING SYSTEM,BACK/SEAT,CUSTO |
| K0261 | WOUND FILLER NOT CLASS GEL/PAS |
| K0262 | WOUND FILLER NOT CLASS DRY FOR |
| K0456 | HOS BED HVY DTY XTRA WIDE W/SI |
| K0457 | COMMODE CHAIR XTRA WIDE HVY DT |
| K0458 | WALKER HVY DTY W/O WHEELS,EA |
| K0459 | WALKER HVY DTY,WHEELED,EA |
| K0553 | SUPPLY ALLOWANCE FOR THERAPEUTIC CONTINUOUS GLUCOSE MONITOR (CGM), INCLUDES ALLSUPPLIES AND ACCESSORIES, 1 MONTH SUPPLY = 1 UNIT OF SERVICE |
| K0554 | RECEIVER (MONITOR), DEDICATED, FOR USE WITH THERAPEUTIC GLUCOSE CONTINUOUS MONITOR SYSTEM |
| K0606 | AUTOMATIC EXTERNAL DEFIBRILLATOR, WITH INTEGRATED ELECTROCARDIOGRAM ANALYSIS, GARMENT TYPE |
| K0800 | POWER OPERATED VEHICLE, GROUP 1 STANDARD, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0801 | POWER OPERATED VEHICLE, GROUP 1 HEAVY DUTY, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0802 | POWER OPERATED VEHICLE, GROUP 1 VERY HEAVY DUTY, PATIENT WEIGHT CAPACITY 451 TO600 POUNDS |
| K0806 | POWER OPERATED VEHICLE, GROUP 2 STANDARD, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0807 | POWER OPERATED VEHICLE, GROUP 2 HEAVY DUTY, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0808 | POWER OPERATED VEHICLE, GROUP 2 VERY HEAVY DUTY, PATIENT WEIGHT CAPACITY 451 TO600 POUNDS |
| K0812 | POWER OPERATED VEHICLE, NOT OTHERWISE CLASSIFIED |
| K0813 | POWER WHEELCHAIR, GROUP 1 STANDARD, PORTABLE, SLING/SOLID SEAT AND BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0814 | POWER WHEELCHAIR, GROUP 1 STANDARD, PORTABLE, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0815 | POWER WHEELCHAIR, GROUP 1 STANDARD, SLING/SOLID SEAT AND BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0816 | POWER WHEELCHAIR, GROUP 1 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0820 | POWER WHEELCHAIR, GROUP 2 STANDARD, PORTABLE, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0821 | POWER WHEELCHAIR, GROUP 2 STANDARD, PORTABLE, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0822 | POWER WHEELCHAIR, GROUP 2 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0823 | POWER WHEELCHAIR, GROUP 2 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0824 | POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0825 | POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0826 | POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0827 | POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0828 | POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE |
| K0829 | POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT 601 POUNDS OR MORE |
| K0835 | POWER WHEELCHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK,PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0836 | POWER WHEELCHAIR, GROUP 2 STANDARD, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0837 | POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0838 | POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0839 | POWER WHEELCHAIR, GROUP 2 VERY HEAVY DUTY, SINGLE POWER OPTION SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0840 | POWER WHEELCHAIR, GROUP 2 EXTRA HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE |
| K0841 | POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0842 | POWER WHEELCHAIR, GROUP 2 STANDARD, MULTIPLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0843 | POWER WHEELCHAIR, GROUP 2 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0848 | POWER WHEELCHAIR, GROUP 3 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0849 | POWER WHEELCHAIR, GROUP 3 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0850 | POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0851 | POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0852 | POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0853 | POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0854 | POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE |
| K0855 | POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE |
| K0856 | POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK,PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0857 | POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0858 | POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT 301 TO 450 POUNDS |
| K0859 | POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0860 | POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0861 | POWER WHEELCHAIR, GROUP 3 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0862 | POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0863 | POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0864 | POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 601 POUNDS OR MORE |
| K0868 | POWER WHEELCHAIR, GROUP 4 STANDARD, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0869 | POWER WHEELCHAIR, GROUP 4 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0870 | POWER WHEELCHAIR, GROUP 4 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0871 | POWER WHEELCHAIR, GROUP 4 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 451 TO 600 POUNDS |
| K0877 | POWER WHEELCHAIR, GROUP 4 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK,PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0878 | POWER WHEELCHAIR, GROUP 4 STANDARD, SINGLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0879 | POWER WHEELCHAIR, GROUP 4 HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0880 | POWER WHEELCHAIR, GROUP 4 VERY HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT 451 TO 600 POUNDS |
| K0884 | POWER WHEELCHAIR, GROUP 4 STANDARD, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0885 | POWER WHEELCHAIR, GROUP 4 STANDARD, MULTIPLE POWER OPTION, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS |
| K0886 | POWER WHEELCHAIR, GROUP 4 HEAVY DUTY, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY 301 TO 450 POUNDS |
| K0890 | POWER WHEELCHAIR, GROUP 5 PEDIATRIC, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 125 POUNDS |
| K0891 | POWER WHEELCHAIR, GROUP 5 PEDIATRIC, MULTIPLE POWER OPTION, SLING/SOLID SEAT/BACK, PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 125 POUNDS |
| K0898 | POWER WHEELCHAIR, NOT OTHERWISE CLASSIFIED |
| K1013 | ENEMA TUBE, WITH OR WITHOUT ADAPTER, ANY TYPE, REPLACEMENT ONLY, EACH |
| K1022 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL, KNEE DISARTICULATION, ABOVE KNEE, HIP DISARTICULATION, POSITIONAL ROTATION UNIT, ANY TYPE |
| L0999 | ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED |
| L1001 | CERVICAL THORACIC LUMBAR SACRAL ORTHOSIS, IMMOBILIZER, INFANT SIZE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L1005 | TENSION BASED SCOLIOSIS ORTHOSIS AND ACCESSORY PADS, INCLUDES FITTING AND ADJUSTMENT |
| L1320 | THORACIC, PECTUS CARINATUM ORTHOSIS, STERNAL COMPRESSION, RIGID CIRCUMFERENTIALFRAME WITH ANTERIOR AND POSTERIOR RIGID PADS, CUSTOM FABRICATED |
| L1499 | SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED |
| L2861 | ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSIONSTYLE MECHANISM FOR CUSTOM FABRICATED ORTHOTICS ONLY, EACH |
| L2999 | LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED |
| L3671 | SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3672 | SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INLCUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3673 | SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, INCLUDES NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3674 | SHOULDER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITH OR WITHOUT NONTORSION JOINT/TURNBUCKLE, MAY INCLUDE SOFTINTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3677 | SHOULDER ORTHOSIS, SHOULDER JOINT DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE |
| L3891 | ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE TORSION STYLE MECHANISM FOR CUSTOM FABRICATED ORTHOTICS ONLY, EACH |
| L3902 | WHFO, EXT POWER, COMPRESSED GA |
| L3904 | WRIST HAND FINGER ORTHOSIS, EXTERNAL POWERED, ELECTRIC, CUSTOM-FABRICATED |
| L3961 | SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3967 | SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE,STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3968 | SHOULDER ELBOW ORTHOSIS, MOBILE ARM SUPPORT ATTACHED TO WHEELCHAIR, BALANCED, FRICTION ARM SUPPORT (FRICTION DAMPENING TO PROXIMAL AND DISTAL JOINTS), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3971 | SHOULDER ELBOW WRIST HAND ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3973 | SHOULDER ELBOW WRIST HAND ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3975 | SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, WITHOUT JOINTS,MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3976 | SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3977 | SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, SHOULDER CAP DESIGN, INCLUDES ONE ORMORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE,STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L3978 | SHOULDER ELBOW WRIST HAND FINGER ORTHOSIS, ABDUCTION POSITIONING (AIRPLANE DESIGN), THORACIC COMPONENT AND SUPPORT BAR, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOMFABRICATED, INCLUDES FITTING AND ADJUSTMENT |
| L5615 | ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, 4 BAR LINKAGE OR MULTIAXIAL, FLUID SWING AND STANCE PHASE CONTROL |
| L5781 | ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENTAND MOISTURE EVACUATION SYSTEM |
| L5782 | ADDITION TO LOWER LIMB PROSTHESIS, VACUUM PUMP, RESIDUAL LIMB VOLUME MANAGEMENTAND MOISTURE EVACUATION SYSTEM, HEAVY DUTY |
| L5846 | ADD ENDO KS MICROPROCESSOR SWI |
| L5847 | ADD,ENDOSKELETON KNEE-SHIN SYS |
| L5856 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING AND STANCE PHASE, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE |
| L5857 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, SWING PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE |
| L5858 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE SHIN SYSTEM, MICROPROCESSOR CONTROL FEATURE, STANCE PHASE ONLY, INCLUDES ELECTRONIC SENSOR(S), ANY TYPE |
| L5859 | ADDITION TO LOWER EXTREMITY PROSTHESIS, ENDOSKELETAL KNEE-SHIN SYSTEM, POWERED AND PROGRAMMABLE FLEXION/EXTENSION ASSIST CONTROL, INCLUDES ANY TYPE MOTOR(S) |
| L5973 | ENDOSKELETAL ANKLE FOOT SYSTEM, MICROPROCESSOR CONTROLLED FEATURE, DORSIFLEXIONAND/OR PLANTAR FLEXION CONTROL, INCLUDES POWER SOURCE |
| L5980 | ALL LOWER EXTREMITY PROSTHESES, FLEX FOOT SYSTEM |
| L5981 | ALL LOWER EXTREMITY PROSTHESES, FLEX-WALK SYSTEM OR EQUAL |
| L5987 | ALL LOWER EXTREMITY PROSTHESIS, SHANK FOOT SYSTEM WITH VERTICAL LOADING PYLON |
| L5999 | LOWER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED |
| L6025 | TRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL POWER, SELF- SUSPENDED, INNER SOCKET WITH REMOVABLE FOREARM SECTION, ELECTRODESAND CABLES, TWO BATTERIES, CHARGER, MYOELECTRIC CONTROL OF TERMINAL DEVICE |
| L6026 | TRANSCARPAL/METACARPAL OR PARTIAL HAND DISARTICULATION PROSTHESIS, EXTERNAL POWER, SELF-SUSPENDED, INNER SOCKET WITH REMOVABLE FOREARM SECTION, ELECTRODESAND CABLES, TWO BATTERIES, CHARGER, MYOELECTRIC CONTROL OF TERMINAL DEVICE, EXCLUDES TERMINAL DEVICE(S) |
| L6028 | PARTIAL HAND, FINGER, AND THUMB PROSTHESIS WITHOUT PROSTHETIC DIGIT(S)/THUMB, AMPUTATION AT METACARPAL LEVEL, INCLUDING FLEXIBLE OR NON-FLEXIBLE INTERFACE, MOLDED TO PATIENT MODEL, INCLUDING PALM, FOR USE WITHOUT EXTERNAL POWER AND/OR PASSIVE PROSTHETIC DIGIT/THUMB, NOT INCLUDING INSERTS DESCRIBED BY L6692 |
| L6029 | UPPER EXTREMITY ADDITION, TEST SOCKET/INTERFACE, PARTIAL HAND INCLUDING FINGERS |
| L6030 | UPPER EXTREMITY ADDITION, EXTERNAL FRAME, PARTIAL HAND INCLUDING FINGERS |
| L6031 | REPLACEMENT SOCKET/INTERFACE, PARTIAL HAND INCLUDING FINGERS, MOLDED TO PATIENTMODEL, FOR USE WITH OR WITHOUT EXTERNAL POWER |
| L6032 | ADDITION TO UPPER EXTREMITY PROSTHESIS, PARTIAL HAND INCLUDING FINGERS, ULTRALIGHT MATERIAL (TITANIUM, CARBON FIBER OR EQUAL) |
| L6033 | ADDITION TO UPPER EXTREMITY PROSTHESIS, PARTIAL HAND INCLUDING FINGERS, ACRYLICMATERIAL |
| L6621 | UPPER EXTREMITY PROSTHESIS ADDITION, FLEXION/EXTENSION WRIST WITH OR WITHOUT FRICTION, FOR USE WITH EXTERNAL POWERED TERMINAL DEVICE |
| L6624 | UPPER EXTREMITY ADDITION, FLEXION/EXTENSION AND ROTATION WRIST UNIT |
| L6638 | UPPER EXTREMITY ADDITION TO PROSTHESIS, ELECTRIC LOCKING FEATURE, ONLY FOR USE WITH MANUALLY POWERED ELBOW |
| L6639 | UPPER EXTREMITY ADDITION, HEAVY DUTY FEATURE, ANY ELBOW |
| L6648 | UPPER EXTREMITY ADDITION, SHOULDER LOCK MECHANISM, EXTERNAL POWERED ACTUATOR |
| L6693 | UPPER EXTREMITY ADDITION, LOCKING ELBOW, FOREARM COUNTERBALANCE |
| L6696 | ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED SOCKET INSERT FOR CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR L6695) |
| L6697 | ADDITION TO UPPER EXTREMITY PROSTHESIS, BELOW ELBOW/ABOVE ELBOW, CUSTOM FABRICATED SOCKET INSERT FOR OTHER THAN CONGENITAL OR ATYPICAL TRAUMATIC AMPUTEE, SILICONE GEL, ELASTOMERIC OR EQUAL, FOR USE WITH OR WITHOUT LOCKING MECHANISM, INITIAL ONLY (FOR OTHER THAN INITIAL, USE CODE L6694 OR L6695) |
| L6700 | TERM DEV HOOK DORRANCE OR EQUA |
| L6711 | TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC |
| L6712 | TERMINAL DEVICE, HOOK, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED, PEDIATRIC |
| L6713 | TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, PEDIATRIC |
| L6714 | TERMINAL DEVICE, HAND, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, PEDIATRIC |
| L6715 | TERM DEV HOOK DORRANCE OR EQUA |
| L6721 | TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY OPENING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED |
| L6722 | TERMINAL DEVICE, HOOK OR HAND, HEAVY DUTY, MECHANICAL, VOLUNTARY CLOSING, ANY MATERIAL, ANY SIZE, LINED OR UNLINED |
| L6880 | TERM DEV HANDS BOCK VO |
| L6881 | AUTOMATIC GRASP FEATURE, ADDITION TO UPPER LIMB ELECTRIC PROSTHETIC TERMINAL DEVICE |
| L6882 | MICROPROCESSOR CONTROL FEATURE, ADDITION TO UPPER LIMB PROSTHETIC TERMINAL DEVICE |
| L6883 | REPLACEMENT SOCKET, BELOW ELBOW/WRIST DISARTICULATION, MOLDED TO PATIENT MODEL,FOR USE WITH OR WITHOUT EXTERNAL POWER |
| L6884 | REPLACEMENT SOCKET, ABOVE ELBOW/ELBOW DISARTICULATION, MOLDED TO PATIENT MODEL,FOR USE WITH OR WITHOUT EXTERNAL POWER |
| L6885 | REPLACEMENT SOCKET, SHOULDER DISARTICULATION/INTERSCAPULAR THORACIC, MOLDED TO PATIENT MODEL, FOR USE WITH OR WITHOUT EXTERNAL POWER |
| L6920 | WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOCK OR EQUAL, SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE |
| L6925 | WRIST DISARTICULATION, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE |
| L6930 | BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE |
| L6935 | BELOW ELBOW, EXTERNAL POWER, SELF-SUSPENDED INNER SOCKET, REMOVABLE FOREARM SHELL, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE |
| L6940 | ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE |
| L6945 | ELBOW DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, OUTSIDE LOCKING HINGES, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE |
| L6950 | ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE |
| L6955 | ABOVE ELBOW, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE HUMERAL SHELL, INTERNAL LOCKING ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE |
| L6960 | SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE |
| L6965 | SHOULDER DISARTICULATION, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE |
| L6970 | INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL SWITCH, CABLES, TWO BATTERIES AND ONE CHARGER, SWITCH CONTROL OF TERMINAL DEVICE |
| L6975 | INTERSCAPULAR-THORACIC, EXTERNAL POWER, MOLDED INNER SOCKET, REMOVABLE SHOULDER SHELL, SHOULDER BULKHEAD, HUMERAL SECTION, MECHANICAL ELBOW, FOREARM, OTTO BOCK OR EQUAL ELECTRODES, CABLES, TWO BATTERIES AND ONE CHARGER, MYOELECTRONIC CONTROL OF TERMINAL DEVICE |
| L7007 | ELECTRIC HAND, SWITCH OR MYOELECTRIC CONTROLLED, ADULT |
| L7008 | ELECTRIC HAND, SWITCH OR MYOELECTRIC, CONTROLLED, PEDIATRIC |
| L7009 | ELECTRIC HOOK, SWITCH OR MYOELECTRIC CONTROLLED, ADULT |
| L7010 | ELECTRC HAND, OTTO BCK,STEEP,E |
| L7015 | ELECTRC HAND, SYS TEKNK,VARTY |
| L7020 | ELECTR GREIFER, OTTO BCK, EQUA |
| L7025 | ELECTR HAND, OTTO BCK, EQUAL, |
| L7030 | ELECTR HAND, SYS TEKNK, VARTY |
| L7035 | ELECTR GREIFER, OTTO BCK, EQUA |
| L7040 | PREHENSILE ACTUATOR, SWITCH CONTROLLED |
| L7045 | ELECTRIC HOOK, SWITCH OR MYOELECTRIC ONTROLLED, PEDIATRIC |
| L7170 | ELECTRONIC ELBOW, HOSMER OR EQUAL, SWITCH CONTROLLED |
| L7180 | ELECTRONIC ELBOW, MICROPROCESSOR SEQUENTIAL CONTROL OF ELBOW AND TERMINAL DEVIC |
| L7181 | ELECTRONIC ELBOW, MICROPROCESSOR SIMULTANEOUS CONTROL OF ELBOW AND TERMINAL DEVICE |
| L7185 | ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED |
| L7186 | ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, SWITCH CONTROLLED |
| L7190 | ELECTRONIC ELBOW, ADOLESCENT, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED |
| L7191 | ELECTRONIC ELBOW, CHILD, VARIETY VILLAGE OR EQUAL, MYOELECTRONICALLY CONTROLLED |
| L7259 | ELECTRONIC WRIST ROTATOR, ANY TYPE |
| L7260 | ELECTRONIC WRIST ROTATOR, OTTO BOCK OR EQUAL |
| L7261 | ELECTRONIC WRIST ROTATOR, FOR UTAH ARM |
| L7266 | SERVO CONTROL, STEEPER OR EQUAL |
| L7272 | ANALOGUE CONTROL, UNB OR EQUAL |
| L7274 | PROPORTIONAL CONTROL, 6-12 VOLT, LIBERTY, UTAH OR EQUAL |
| L7499 | UPPER EXTREMITY PROSTHESIS, NOT OTHERWISE SPECIFIED |
| L7900 | MALE VACUUM ERECTION SYSTEM |
| L8035 | CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL |
| L8499 | UNLISTED PROCEDURE FOR MISCELLANEOUS PROSTHETIC SERVICES |
| L8692 | AUDITORY OSSEOINTEGRATED DEVICE, EXTERNAL SOUND PROCESSOR, USED WITHOUT OSSEOINTEGRATION, BODY WORN, INCLUDES HEADBAND OR OTHER MEANS OF EXTERNAL ATTACHMENT |
| S5001 | PRESCRIPTION DRUG, BRAND NAME |
| S8032 | LOW-DOSE COMPUTED TOMOGRAPHY FOR LUNG CANCER SCREENING |
| S8189 | TRACHEOSTOMY SUPPLY, NOT OTHERWISE CLASSIFIED |
| S9123 | NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NOT TO BE USED WHEN CPT CODES 99500-99602 CAN BE USED) |
| S9124 | NURSING CARE, IN THE HOME; BY LICENSED PRACTICAL NURSE, PER HOUR |
| T1002 | RN SERVICES, UP TO 15 MINUTES |
| T1003 | LPN/LVN SERVICES, UP TO 15 MINUTES |
| T4543 | ADULT SIZED DISPOSABLE INCONTINENCE PRODUCT, PROTECTIVE BRIEF/DIAPER, ABOVE EXTRA LARGE, EACH |
| T5999 | SUPPLY,NOT OTHERWISE SPECIFIED |
| V2199 | NOT OTHERWISE CLASSIFIED, SINGLE VISION LENS |
| V2499 | VARIABLE SPHERICITY LENS, OTHER TYPE |
| V2740 | TINT, PLASTIC, ROSE 1 OR 2 PER LENS |
| V2741 | TINT, PLASTIC, OTHER THAN ROSE 1-2, PER LENS |
| V2742 | TINT, GLASS ROSE 1 OR 2, PER LENS |
| V2743 | TINT, GLASS OTHER THAN ROSE 1 OR 2, PER LENS |
| V2799 | VISION ITEM OR SERVICE, MISCELLANEOUS |
| V5030 | HEARING AID MONAURAL, BODY WOR |
| V5040 | HEARING AID-MONAURAL-BODY WORN |
| V5090 | DISPENSING FEE FOR ONE HEARING |
| V5170 | HEARING AID, CROS, IN THE EAR |
| V5171 | HEARING AID, CONTRALATERAL ROUTING DEVICE, MONAURAL, IN THE EAR (ITE) |
| V5180 | HEARING AID, CROS, BEHIND THE EAR |
| V5181 | HEARING AID, CONTRALATERAL ROUTING DEVICE, MONAURAL, BEHIND THE EAR (BTE) |
| V5190 | HEARING AID, CONTRALATERAL ROUTING, MONAURAL, GLASSES |
| V5200 | DISPENSING FEE, CONTRALATERAL, MONAURAL |
| V5210 | HEARING AID, BICROS, IN THE EAR |
| V5211 | HEARING AID, CONTRALATERAL ROUTING SYSTEM, BINAURAL, ITE/ITE |
| V5213 | HEARING AID, CONTRALATERAL ROUTING SYSTEM, BINAURAL, ITE/BTE |
| V5220 | HEARING AID, BICROS, BEHIND THE EAR |
| V5221 | HEARING AID, CONTRALATERAL ROUTING SYSTEM, BINAURAL, BTE/BTE |
| V5230 | HEARING AID, CONTRALATERAL ROUTING SYSTEM, BINAURAL, GLASSES |
| V5240 | DISPENSING FEE, CONTRALATERAL ROUTING SYSTEM, BINAURAL |
| Z3914 | MANUAL RESUSCITATOR |
| Z3956 | WALKER/TRAINER,WHEELED,ADJUSTA |
| Z4710 | AUGMENTATIVE COMMUNICATION SYS |
| Z4911 | LABOR (MECHANICAL), PER HALF H |
| Z4912 | LABOR (ELECTRICAL), PER HALF H |
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